Epidemiology and impact of frailty in patients with atrial fibrillation in Europe
Why the study?
Frailty is characterised by reduced physiological reserve, but data regarding the relationship between frailty and AF are still inconsistent.
Does frailty impact clinical management and risk of adverse outcomes in patients with atrial fibrillation?
Population
10,177 AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry
Comparison
Frailty status assessed by a 40-item frailty index (pre-frail and frail vs robust)
Design
Registry-based cohort study
Authors
Discussion
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Member takes
Implication
Frailty assessment may aid risk stratification in AF; leaves open whether interventions targeting frailty improve outcomes.
Key Points
- To comprehensively evaluate the prevalence, management patterns, and prognostic impact of frailty in a large European cohort of patients with atrial fibrillation.
- Assessed 10,177 patients with atrial fibrillation enrolled in the ESC-EHRA EORP-AF General Long-Term Registry (mean age 69.0 years, 40.3% female).
- Constructed a 40-item frailty index (FI) using the accumulation of deficits model to evaluate associations with baseline risk, management strategies, and adverse clinical outcomes.
- Baseline categorization identified 59.6% (n=6,066) of patients as pre-frail, 21.3% (n=2,172) as frail, and only 19.1% (n=1,939) as robust.
- Frail patients were significantly less likely to receive oral anticoagulants (OR 0.70, 95% CI 0.55–0.89) or rhythm control interventions compared to robust patients.
- Increasing frailty was non-linearly associated with higher adverse outcome rates; oral anticoagulation reduced event risks in most patients but lost effectiveness in very high to extreme frailty.
Structured PICO
Does frailty impact clinical management and risk of adverse outcomes in patients with atrial fibrillation?
P
Population
10,177 patients with atrial fibrillation enrolled in the ESC-EHRA EORP-AF General Long-Term Registry, mean age 69.0 years, 40.3% female, in Europe.
I
Intervention
Frailty (assessed by a 40-item frailty index)
C
Comparator
Robust patients (no frailty)
O
Outcome
Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty
Frailty is highly prevalent in European AF patients and is associated with lower OAC use and higher risk of adverse outcomes, though OAC benefit is maintained except in the extremely frail.
Cite This Study
Romiti et al. (2022) studied this question.