In older patients with AF eligible for oral anticoagulation, severe frailty compared with being fit was associated with an increased risk of death (HR 4.09; 95% CI 3.43-4.89).
Why the study?
How does frailty affect oral anticoagulation prescription rates and clinical outcomes in older patients with atrial fibrillation?
Population
536,955 patients aged ≥65 years from 384 General Practices in England
Comparison
Electronic frailty index categories of fit, mild, moderate, and severe frailty
Design
Electronic health records cohort study
Follow-up
15.4 months
Key result
In older patients with AF eligible for oral anticoagulation, severe frailty compared with being fit was associated with an increased risk of death (HR 4.09; 95% CI 3.43-4.89).
Authors
Discussion
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Overview
Severe frailty signals substantially higher mortality in older AF patients eligible for OAC; hypothesis-generating for frailty-stratified anticoagulation decisions.
Study Design
Type
Cohort (n=536,955)
Multicenter
Yes
Structured PICO
How does frailty affect oral anticoagulation prescription rates and clinical outcomes in older patients with atrial fibrillation?
P
Population
536,955 patients aged ≥65 years from 384 General Practices in England, analyzed by electronic frailty index (eFI) category (fit, mild, moderate, severe).
I
Intervention
Oral anticoagulation (OAC) prescription
C
Comparator
Fit frailty category (for outcomes comparison)
O
Outcome
OAC prescription rate for AF with CHA2DS2-Vasc ≥2, and adjusted risk of all-cause mortality, cerebrovascular disease, bleeding, and fallshard clinical
Main Result
Effect estimate: HR 4.09 (95% CI 3.43-4.89)
In older patients with atrial fibrillation, increasing frailty is associated with higher stroke risk and competing risks of death, bleeding, and falls, yet oral anticoagulation prescription rates remain around 50% across frailty categories.
Cite This Study
Wilkinson et al. (2020) conducted a cohort in Atrial fibrillation and frailty (n=536,955). Severe frailty vs. Fit (no frailty) was evaluated on All-cause mortality (HR 4.09, 95% CI 3.43-4.89). In older patients with AF eligible for oral anticoagulation, severe frailty compared with being fit was associated with an increased risk of death (HR 4.09; 95% CI 3.43-4.89).