Frailty in patients affected by atrial fibrillation

Polidoro, Alessandro; Stefanelli, Francesco; Ciacciarelli, Marco; Pacelli, Antonio; Sanzo, Daniela Di; Alessandri, Cristiano

doi:10.1016/j.archger.2013.04.014

Cited by 82 publications

(82 citation statements)

References 32 publications

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“…After excluding 8,897 papers on the grounds of a review of their titles and abstracts, 56 full-text articles were examined, and 21 articles(Avila-Funes et al, 2014; Blaum et al, 2005; Chaves, 2005; Danon-Hersch et al, 2012; de Albuquerque Sousa et al, 2012; Dumurgier et al, 2009; Eichholzer et al, 2012; Ekerstad et al, 2011; Frisoli et al, 2015; Green et al, 2012; Hajjar et al, 2009; Khan et al, 2013; Lin et al, 2015; Moreira and Lourenco, 2013; Moretti et al, 2013; Polidoro et al, 2013; Ramsay et al, 2015; Ricci et al., 2014; Sanchis et al, 2014; Sergi et al, 2015; Wong et al, 2010) corresponding to 18 cohorts were finally included in our meta-analysis (Figure 1). …”

Section: Resultsmentioning

confidence: 99%

“…The 18 cohorts (Avila-Funes et al, 2014; Blaum et al, 2005; Chaves, 2005; Danon-Hersch et al, 2012; de Albuquerque Sousa et al, 2012; Dumurgier et al, 2009; Eichholzer et al, 2012; Ekerstad et al, 2011; Frisoli et al, 2015; Green et al, 2012; Lin et al, 2015; Moreira and Lourenco, 2013; Moretti et al, 2013; Polidoro et al., 2013; Ramsay et al, 2015; Ricci et al, 2014; Sanchis et al, 2014; Sergi et al, 2015; Wong et al., 2010) included 4,469 frail participants out of 31,343 older subjects (eTable 3). Ten cohorts provided data on pre-frail (n=7,294) and robust (n=6,875) participants, while 8 (Chaves, 2005; Eichholzer et al, 2012; Ekerstad et al, 2011; Green et al, 2012; Khan et al, 2013; Moretti et al, 2013; Polidoro et al, 2013; Ricci et al, 2014) compared frail (n=2,305) to pre-frail/robust participants (n=12,705).…”

Section: Resultsmentioning

confidence: 99%

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Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis

Veronese

Cereda

Stubbs

et al. 2017

Ageing Research Reviews

212

136

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Frailty is common and associated with poorer outcomes in the elderly, but its role as potential cardiovascular disease (CVD) risk factor requires clarification. We thus aimed to meta-analytically evaluate the evidence of frailty and pre-frailty as risk factors for CVD. Two reviewers selected all studies comparing data about CVD prevalence or incidence rates between frail/pre-frail vs. robust. The association between frailty status and CVD in cross-sectional studies was explored by calculating and pooling crude and adjusted odds ratios (ORs) ±95% confidence intervals (CIs); the data from longitudinal studies were pooled using the adjusted hazard ratios (HRs). Eighteen cohorts with a total of 31,343 participants were meta-analyzed. Using estimates from 10 cross-sectional cohorts, both frailty and pre-frailty were associated with higher odds of CVD than robust participants. Longitudinal data were obtained from 6 prospective cohort studies. After a median follow-up of 4.4 years, we identified an increased risk for faster onset of any-type CVD in the frail (HR=1.70 [95%CI, 1.18–2.45]; I2=66%) and pre-frail (HR=1.23 [95%CI, 1.07–1.36]; I2=67%) vs. robust groups. Similar results were apparent for time to CVD mortality in the frail and pre-frail groups. In conclusion, frailty and pre-frailty constitute addressable and independent risk factors for CVD in older adults.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis

Veronese

Cereda

Stubbs

et al. 2017

Ageing Research Reviews

212

136

View full text Add to dashboard Cite

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“…Studies of hospitalized patients have reported increased disability and frailty in older adults with AF, but relied on self-reported disability and did not use a validated definition of frailty. 36,37 Perception of frailty has been reported as a fall risk in anticoagulation for stroke prevention in AF, 38 but again not using validated criteria for frailty. Our analyses extend these prior findings that AF is associated with a decline in physical performance in aging, and underscore the importance of more formal evaluations of the contributions of AF towards frailty and longitudinal adversity in aging.…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Declining Physical Performance in Older Adults

Magnani

Wang

Benjamin

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background Age is the foremost risk factor for atrial fibrillation (AF) and AF has a rising prevalence in older adults. How AF may contribute to decline in physical performance in older adults has had limited investigation. We examined the associations of incident AF and 4-year interval declines in physical performance at ages 70, 74, 78, and 82 years in the Health, Aging, and Body Composition (Health ABC) Study. Methods and Results Health ABC is a prospective cohort of community-dwelling older adults (n=3075). The study conducted serial assessments of physical performance with the Health ABC physical performance battery (PPB, scored 0-4), grip strength, 2-minute walk distance, and 400-meter walking time. Incident AF was identified from the Center for Medicare and Medicaid Services, and related to 4-year interval decline in physical performance. Following exclusions, the analysis included 2753 Health ABC participants (52% women, 41% black race). Participants with AF had a significantly greater 4-year PPB decline than those without AF at age 70, 74, 78, and 82, with mean estimated decline ranging from −.08 to −0.10 units (95% confidence interval, −0.18 to −0.01; P<0.05 for all estimates) following multivariable adjustment. Grip strength, walk distance, and walk time similarly showed significantly greater declines at each 4-year age interval in participants with AF. Conclusions In community-based cohort older adults, incident AF was associated with increased risk of decline in physical performance. Further research is essential to identify mechanisms and preventive strategies for how AF may contribute towards declining physical performance in older adults.

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“…For this reason, it is estimated NVAF patients have as high as a 4‐fold increased odds of being classified as frail compared with non‐NVAF patients 1. Despite being at an increased risk of thromboembolic events because of NVAF, frail patients appear less likely to receive adequate oral anticoagulation (OAC) compared with non‐frail patients 4, 5, 6.…”

mentioning

confidence: 99%

Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban Versus Warfarin in Frail Patients With Nonvalvular Atrial Fibrillation

Martinez

Sood

Bunz³

et al. 2018

JAHA

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BackgroundFrailty predicts poorer outcomes and decreased anticoagulation use in patients with nonvalvular atrial fibrillation. We sought to assess the effectiveness and safety of apixaban, dabigatran and rivaroxaban versus warfarin in frail nonvalvular atrial fibrillation patients.Methods and ResultsUsing US MarketScan claims data from November 2011 to December 2016, we identified frail oral anticoagulant‐naïve nonvalvular atrial fibrillation patients with ≥12 months of continuous insurance coverage before oral anticoagulant initiation. Frailty status was determined using the Johns Hopkins Claims‐based Frailty Indicator score (≥0.20 indicating frailty). Users of apixaban, dabigatran, or rivaroxaban were separately 1:1 matched to warfarin users via propensity‐scores, with residual absolute standardized differences <0.1 being achieved for all covariates after matching. Patients were followed for up to 2 years or until an event, insurance disenrollment or end of follow‐up. Rates of stroke or systemic embolism and major bleeding were compared using Cox regression and reported as hazard ratios (HRs) and 95% confidence intervals (CIs). In total, 2700, 2784, and 5270 patients were included in the apixaban, dabigatran, and rivaroxaban 1:1 matched analyses to warfarin. At 2 years, neither apixaban nor dabigatran were associated with differences in the hazard of stroke or systemic embolism (HR=0.78; 95% CI=0.46–1.35 and HR=0.94; 0.60–1.45) or major bleeding (HR=0.72; 95% CI=0.49–1.06 and HR=0.87; 95% CI=0.63–1.19) versus warfarin. Rivaroxaban was associated with reduced stroke or systemic embolism at 2 years (HR=0.68; 95% CI=0.49–0.95) without significantly altering major bleeding risk (HR=1.07; 95% CI=0.81–1.32).ConclusionsOur study found rivaroxaban but not apixaban or dabigatran to be associated with reduced SSE versus warfarin in frail nonvalvular atrial fibrillation patients. No direct‐acting oral anticoagulants demonstrated a significant difference in major bleeding versus warfarin.

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Frailty in patients affected by atrial fibrillation

Cited by 82 publications

References 32 publications

Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis

Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis

Atrial Fibrillation and Declining Physical Performance in Older Adults

Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban Versus Warfarin in Frail Patients With Nonvalvular Atrial Fibrillation

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