Frailty and subsequent adverse outcomes in older patients with atrial fibrillation treated with oral anticoagulants: The Shizuoka study

Nishimura, Shiori; Kumamaru, Hiraku; Shoji, Shuichi; Nakatani, Eiji; Yamamoto, Hiroyuki; Ichihara, Nao; Sandhu, Alexander T.; Matsubara, Hiroaki; Kohsaka, Shun

doi:10.1016/j.rpth.2023.100129

Cited by 3 publications

(3 citation statements)

References 38 publications

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“…To conclude, the study by Nishimura et al. [ 4 ] once again demonstrates the association between frailty and bleeding in frail elderly patients with AF. This emphasizes the need for monitoring bleeding risk in clinical practice and exploring more optimal anticoagulant strategies for these vulnerable patients in research.…”

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confidence: 80%

“…In this edition of Research and Practice in Thrombosis and Haemostasis , Nishimura et al. [ 4 ] describe the results of their study on the association between frailty and bleeding and ischemic stroke/transient ischemic attack (TIA) in patients with AF at the time of anticoagulant initiation. Patients aged ≥65 years with nonvalvular AF who initiated anticoagulants were selected from an administrative claims database in Japan between 2012 and 2018.…”

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confidence: 99%

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Anticoagulants in frail elderly patients with atrial fibrillation: a delicate balance

Trinks-Roerdink

Geersing

2023

Research and Practice in Thrombosis and Haemostasis

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confidence: 80%

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confidence: 99%

Anticoagulants in frail elderly patients with atrial fibrillation: a delicate balance

Trinks-Roerdink

Geersing

2023

Research and Practice in Thrombosis and Haemostasis

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“…We have previously reported that the risk of bleeding among NOAC initiators increased with the severity of frailty, whereas for vitamin K antagonist initiators, this increase was more contained as frailty severity rose, using a large-scale observational study from Japan. 3 It is also crucial to acknowledge that in certain regions with a higher bleeding risk compared to Western countries, clinical practice guidelines accommodate a lower international normalized ratio range for warfarin. For instance, Japanese clinical practice guidelines recommend lower international normalized ratio levels (1.6-2.6) for patients older than 70 years.…”

Section: To the Editormentioning

confidence: 99%

Letter by Kohsaka et al Regarding Article, “Safety of Switching From a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients With Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial”

Kohsaka,

Nishimura,

Kumamaru

2024

Circulation

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Trajectories of Frailty and Clinical Outcomes in Older Adults With Atrial Fibrillation: Insights From the Shizuoka Kokuho Database

Nakamaru,

Nishimura,

Kumamaru

et al. 2024

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND: The increasing prevalence of frailty has gained considerable attention due to its profound influence on clinical outcomes. However, our understanding of the progression of frailty and long-term clinical outcomes in older individuals with atrial fibrillation remains scarce. METHODS: Using data from 2012 to 2018 from a comprehensive claims database incorporating primary and hospital care records in Shizuoka, Japan, we selected patients aged ≥65 years with atrial fibrillation who initiated oral anticoagulant therapy. The trajectory of frailty was plotted using Sankey plots, illustrating the annual changes in their frailty according to the electronic frailty index during a 3-year follow-up after oral anticoagulant initiation, along with the incidence of clinical adverse outcomes. For deceased patients, we assessed their frailty status in the year preceding their death. RESULTS: Of 6247 eligible patients (45.1% women; mean age, 79.3±8.0 years) at oral anticoagulant initiation, 7.7% were categorized as fit (electronic frailty index, 0–0.12), 30.1% as mildly frail (>0.12–0.24), 35.4% as moderately frail (>0.24–0.36), and 25.9% as severely frail (>0.36). Over the 3-year follow-up, 10.4% of initially fit patients transitioned to moderately frail or severely frail. Conversely, 12.5% of severely frail patients improved to fit or mildly frail. Death, stroke, and major bleeding occurred in 23.4%, 4.1%, and 2.2% of patients, respectively. Among the mortality cases, 74.8% (N=1183) and 3.5% (N=55) had experienced moderately or severely frail and either a stroke or major bleeding in the year preceding their death, respectively. CONCLUSIONS: In a contemporary era of atrial fibrillation management, a minor fraction of older patients on oral anticoagulants died following a stroke or major bleeding. However, their frailty demonstrated a dynamic trajectory, and a substantial proportion of death was observed after transitioning to a moderately or severely frail state.

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Frailty and subsequent adverse outcomes in older patients with atrial fibrillation treated with oral anticoagulants: The Shizuoka study

Cited by 3 publications

References 38 publications

Anticoagulants in frail elderly patients with atrial fibrillation: a delicate balance

Anticoagulants in frail elderly patients with atrial fibrillation: a delicate balance

Letter by Kohsaka et al Regarding Article, “Safety of Switching From a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients With Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial”

Trajectories of Frailty and Clinical Outcomes in Older Adults With Atrial Fibrillation: Insights From the Shizuoka Kokuho Database

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