Frailty and outcomes in older adults with non-valvular atrial fibrillation from the ANAFIE registry

Akishita, Masahiro; Suzuki, Shinya; Inoue, Hiroshi; Akao, Masaharu; Atarashi, Hirotsugu; Ikeda, Takanori; Koretsune, Yukihiro; Okumura, Ken; Shimizu, Wataru; Tsutsui, Hiroyuki; Toyoda, Kazunori; Hirayama, Atsushi; Yasaka, Masahiro; Yamaguchi, Takenori; Teramukai, Satoshi; Kimur, Tetsuya; Morishima, Yasuo; Takita, Atsushi; Yamashita, Takeshi

doi:10.1016/j.archger.2022.104661

Cited by 15 publications

(13 citation statements)

References 32 publications

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“…Recently, we reported that frailty was associated with cardiovascular and allcause death, net clinical outcomes (a composite of stroke/systemic embolic events, major bleeding and all-cause death), and major bleeding, but not stroke or intracranial hemorrhage in a 3000-patient subcohort of the All Nippon AF In the Elderly (ANAFIE) Registry, a nationwide registry with older Japanese adults with non-valvular AF. 4 In that study, we analyzed the frailty status using the Kihon Checklist, a deficit accumulation model of frailty assessment. Here, we report the additional analysis of the ANAFIE Registry on the association of frailty with AF outcomes using the Frailty Screening Index, a phenotype model of frailty assessment.…”

Section: Dear Editormentioning

confidence: 99%

Section: Dear Editormentioning

confidence: 99%

“…Physical frailty was measured using the 5-item Japanese version of the Cardiovascular Health Study (J-CHS) criteria. 4 Briefly, physical frailty was defined as a situation in which three or more of the following characteristics were present: unintentional weight loss (≥2 kg within the past year), self-reported exhaustion, low grip strength, slow walking speed, and low physical activity. This study was approved by the Ethics Committee of Human Research at the National Center for Geriatrics and Gerontology, Japan (no.…”

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confidence: 99%

“…Consistent findings seen in our previous Kihon Checklist study and this study are that frailty was independently associated with all-cause death and net clinical outcomes by the three category analysis, and that the robust + prefrail versus frail analysis showed an additional association of frailty with cardiovascular death. 4 In contrast, the results on stroke/SEE and major bleeding, a doubleedged sword in AF management, were different between the two studies. The robust + prefrail versus frail analysis in the present study showed an independent association of frailty with stroke/ SEE, whereas major bleeding was associated with frailty by a similar analysis in the Kihon Checklist study.…”

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confidence: 95%

“…The robust + prefrail versus frail analysis in the present study showed an independent association of frailty with stroke/ SEE, whereas major bleeding was associated with frailty by a similar analysis in the Kihon Checklist study. 4 The Frailty Screening Index and the Kihon Checklist are different types (phenotype model vs deficit accumulation model) of frailty assessment tools. As a result, the prevalence of frailty was lower in the present study than in the Kihon Checklist study (19.5% vs 36.2%) using almost the same cohort.…”

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confidence: 99%

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Frailty screening index and atrial fibrillation outcomes in the All Nippon AF In the Elderly registry

Akishita

Suzuki

Inoue

et al. 2022

Geriatrics Gerontology Int

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clinical outcomes in patients with myocardial infarction complicated by HF. 6 However, hypermagnesemia, but not hypomagnesemia, was associated with cardiovascular and allcause mortalities in HF patients in the meta-analysis. 7 These conflicting results are partly attributable to extents of Mg alterations; that is, the EPHESUS study defined hypomagnesemia and hypermagnesemia as serum Mg concentrations <0.66 mmol/L (1.58 mg/dL) and >1.10 mmol/L (2.64 mg/dL), respectively, 6 whereas these alterations were defined as serum Mg ≤1.5 mEq/L (1. 8 mg/dL) and ≥1.9 mEq/L (2.28 mg/dL) in the PROMISE study. 5 In conclusion, a senile hypertensive patient presented HF caused by bradyarrhythmia and hypotension under hypermagnesemia. Mg-containing laxative in the gut acts as a reservoir of Mg in constipated patients. 8 Hypermagnesemia exacerbates HF by: (i) negative inotropic and chronotropic actions of Mg; and (ii) hypoperfusion of multiple organs induced by Mg-induced excessive vasodilation. It is of clinical importance to monitor electrolytes, and to review prescription for prevention of hypermagnesemia worsening hemodynamics in senile patients with constipation and renal insufficiency.

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Section: Dear Editormentioning

confidence: 99%

Section: Dear Editormentioning

confidence: 99%

Section: Disclosure Statementmentioning

confidence: 99%

mentioning

confidence: 95%

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confidence: 99%

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Frailty screening index and atrial fibrillation outcomes in the All Nippon AF In the Elderly registry

Akishita

Suzuki

Inoue

et al. 2022

Geriatrics Gerontology Int

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Cost‐Effectiveness and Budget Impact Analysis of Apixaban and Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Non‐Valvular Atrial Fibrillation (NVAF) in Iran

Tajik,

Abbasi,

Goudarzi

et al. 2024

Clinical Cardiology

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IntroductionThis study evaluates the cost‐effectiveness of Apixaban and Rivaroxaban, compared to Warfarin, for stroke prevention in patients with non‐valvular atrial fibrillation in Iran.MethodA Markov model with a 30‐year time horizon was employed to simulate and assess different treatment strategies' cost‐effectiveness. The study population comprised Iranian adults with NVAF, identified through specialist consultations, hospital visits, and archival record reviews. Direct medical costs, direct nonmedical, and indirect costs were included. Quality‐adjusted life years (QALY) were assessed using an EQ‐5D questionnaire. This study utilized a cost‐effectiveness threshold of $11 134 per QALY.ResultsApixaban demonstrated superior cost‐effectiveness compared to Rivaroxaban and Warfarin. Over 30 years, total costs were lower in the Apixaban and Rivaroxaban groups compared to the Warfarin group ($126.18 and $109.99 vs. $150.49). However, Apixaban showed higher total QALYs gained compared to others (0.134 vs. 0.133 and 0.116). The incremental cost‐effectiveness ratio for comparing Apixaban to Warfarin was calculated at −1332.83 cost per QALY, below the threshold of $11 134, indicating Apixaban's cost‐effectiveness. Sensitivity analyses confirmed the robustness of the findings, with ICER consistently remaining below the threshold. Over 5 years (2024−2028) of Apixaban usage, the incremental cost starts at USD 70 250 296 in the first year and gradually rises to USD 71 770 662 in the fifth year. DSA and PSA were assessed to prove the robustness of the results.ConclusionThis study shows that Apixaban is a cost‐effective option for stroke prevention in non‐valvular atrial fibrillation patients in Iran compared to Warfarin.

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The burden of frailty in heart failure: Prevalence, impacts on clinical outcomes and the role of heart failure medications

Lai,

Huang,

Anker

et al. 2024

J cachexia sarcopenia muscle

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BackgroundFrailty often coexists with heart failure (HF), which significantly aggravates the clinical outcomes of older adults. However, studies investigating the interplay between frailty and HF in older adults are scarce. We aimed to assess the prevalence of frailty using the cumulative deficit approach and evaluate the impacts of frailty on health utilization, use of HF‐related medications and adverse clinical outcomes (all‐cause mortality, all‐cause readmissions and HF readmissions) among older HF patients.MethodsA total of 38 843 newly admitted HF patients were identified from Taiwan's National Health Insurance Research Database and categorized into three frailty subgroups (fit, mild frailty and severe frailty) based on the multimorbidity frailty index. Cox regression models and Fine and Gray subdistribution hazard models were used to estimate the impacts of frailty on clinical outcomes at 1 and 2 years of follow‐up. Generalized estimating equation models were further conducted to evaluate the associations between longitudinal and time‐varying use of HF‐related medications and clinical outcomes among distinct frailty subgroups.ResultsOf 38 843 older HF patients (mean age 80.4 ± 8.5 years, 52.3% females) identified, 68.3% were categorized as frail (47.5% of mild frailty and 20.8% of severe frailty). The median number of readmissions (fit: 1 [inter‐quartile range—IQR 2], mild frailty: 1 [IQR 2] and severe frailty: 2 [IQR 3]) increased with the severity of frailty. Only 27.3% of HF patients died of cardiovascular diseases regardless of their frailty status. Compared with the fit group, the severe frailty group was associated with increased risk of all‐cause mortality (adjusted hazard ratio 1.16, 95% confidence interval [CI] 1.11–1.21), all‐cause readmissions (subdistributional hazard ratio (sHR) 1.21, 95% CI 1.16–1.25) and HF‐related readmissions (sHR 1.14, 95% CI 1.09–1.20) at 2 years of follow‐up. Those who used triple or more HF‐related medications were at lower risk for all‐cause readmissions (adjusted odds ratio [aOR] 0.49, 95% CI 0.44–0.54) and HF‐related readmissions (aOR 0.42, 95% CI 0.37–0.47) at 2 years of follow‐up even in the severe frailty group.ConclusionsFrailty is highly prevalent and associated with increased risk of all‐cause mortality, all‐cause readmissions and HF readmissions among older HF patients. Those who were using triple or more HF‐related medications were at lower risk of adverse clinical outcomes across distinct frailty subgroups. Further studies are needed to optimize the treatment strategies for older HF patients with distinct frailty status.

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Frailty and outcomes in older adults with non-valvular atrial fibrillation from the ANAFIE registry

Cited by 15 publications

References 32 publications

Frailty screening index and atrial fibrillation outcomes in the All Nippon AF In the Elderly registry

Frailty screening index and atrial fibrillation outcomes in the All Nippon AF In the Elderly registry

Cost‐Effectiveness and Budget Impact Analysis of Apixaban and Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Non‐Valvular Atrial Fibrillation (NVAF) in Iran

The burden of frailty in heart failure: Prevalence, impacts on clinical outcomes and the role of heart failure medications

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