Epidemiology and impact of frailty in patients with atrial fibrillation in Europe.


Journal

Age and ageing
ISSN: 1468-2834
Titre abrégé: Age Ageing
Pays: England
ID NLM: 0375655

Informations de publication

Date de publication:
02 08 2022
Historique:
received: 17 03 2022
revised: 08 06 2022
entrez: 23 8 2022
pubmed: 24 8 2022
medline: 25 8 2022
Statut: ppublish

Résumé

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Sections du résumé

BACKGROUND
Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.
OBJECTIVES
We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.
METHODS
A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.
RESULTS
Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.
CONCLUSIONS
In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Identifiants

pubmed: 35997262
pii: 6670566
doi: 10.1093/ageing/afac192
pii:
doi:

Substances chimiques

Anticoagulants 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

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Informations de copyright

© The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Auteurs

Marco Proietti (M)

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.

Giulio Francesco Romiti (GF)

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy.

Marco Vitolo (M)

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.

Stephanie L Harrison (SL)

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.

Deirdre A Lane (DA)

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Laurent Fauchier (L)

Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France.

Francisco Marin (F)

Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain.

Michael Näbauer (M)

Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany.

Tatjana S Potpara (TS)

School of Medicine, University of Belgrade, Belgrade, Serbia.
Clinical Center of Serbia, Belgrade, Serbia.

Gheorghe-Andrei Dan (GA)

University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania.

Aldo P Maggioni (AP)

ANMCO Research Center, Heart Care Foundation, Florence, Italy.

Matteo Cesari (M)

Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.

Giuseppe Boriani (G)

Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.

Gregory Y H Lip (GYH)

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

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