How do frailty and advanced age impact clinical outcomes and the safety and efficacy of treatments in patients with atrial fibrillation?
Frailty and advanced age in AF patients are associated with significantly higher mortality, stroke, and bleeding risks, complicating the efficacy and safety of standard therapies like NOACs and ablation.
Atrial fibrillation (AF) is common among frail older adults and poses complex management challenges due to reduced physiological reserve and heightened vulnerability to adverse outcomes. This systematic review (2015–2025) examined influence of frailty and advanced age on AF management and outcomes, focusing on anticoagulation, interventional therapies and quality of life. Eligible cohort studies, trials, meta-analyses assessed outcomes including mortality, stroke, major bleeding, functional decline, recurrence, healthcare costs and quality of life with frailty measured using validated tools like Clinical Frailty Scale. Frail patients had a two- to threefold higher mortality risk and 40–50% greater incidence of stroke and major bleeding than non-frail peers. Low-dose NOACs reduced stroke in frail octogenarians but bleeding risk persisted. Rate control therapy improved symptoms yet increased hypotension risk. Catheter ablation showed lower success and more complications. Severe frailty and age ≥85 were associated with poorer outcomes, higher utilization and reduced quality of life.
Batta et al. (Wed,) studied this question.
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