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

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.

Déclaration de conflit d'intérêts

Dr Kohsaka received an investigator-initiated grant from Novartis. Dr Kumamaru received consultation fees from Mitsubishi Tanabe Pharma and speaker’s fees from Pfizer Japan, Inc, and Johnson & Johnson K.K. Dr Yamamoto received consultation fees from Mitsubishi Tanabe Pharma, speaker’s fees from Chugai Pharmaceutical Co., Ltd., and Ono Pharmaceutical Co., Ltd., and payment for an article from Astellas Pharma, Inc. Dr Miyata received a research grant from AstraZeneca K.K. for an independent research project through the PeoPLe Consortium at Keio University. Drs Nakamaru, Nishimura, Kumamaru, Yamamoto, Miyata, and Kohsaka are affiliated with the Department of Healthcare Quality Assessment, The University of Tokyo. This department is a social collaboration department supported by the National Clinical Database, Johnson & Johnson K.K., Nipro Corporation, and Intuitive Surgical Sàrl. The other authors report no conflicts.