Key result
Frailty and pre-frailty in patients with atrial fibrillation were associated with a higher risk of unplanned hospitalizations.
Why the study?
Atrial fibrillation and frailty are common and increasing, but the prevalence of frailty and the ability of a frailty index to predict unplanned hospitalizations, stroke, bleeding, and death in AF patients required investigation.
Does frailty predict unplanned hospitalization, stroke, bleeding, and death in patients with atrial fibrillation?
Cohort (n=2,369)
Does frailty predict unplanned hospitalization, stroke, bleeding, and death in patients with atrial fibrillation?
Over two-thirds of patients with atrial fibrillation are pre-frail or frail, which strongly predicts unplanned hospitalizations, mortality, bleeding, and stroke.
Answers are grounded in this paper and cite their sources.
Frailty assessment may aid AF risk stratification; leaves open whether interventions modify outcomes.
AIMS: Atrial fibrillation (AF) and frailty are common, and the prevalence is expected to rise further. We aimed to investigate the prevalence of frailty and the ability of a frailty index (FI) to predict unplanned hospitalizations, stroke, bleeding, and death in patients with AF. METHODS AND RESULTS: Patients with known AF were enrolled in a prospective cohort study in Switzerland. Information on medical history, lifestyle factors, and clinical measurements were obtained. The primary outcome was unplanned hospitalization; secondary outcomes were all-cause mortality, bleeding, and stroke. The FI was measured using a cumulative deficit approach, constructed according to previously published criteria and divided into three groups (non-frail, pre-frail, and frail). The association between frailty and outcomes was assessed using multivariable-adjusted Cox regression models. Of the 2369 included patients, prevalence of pre-frailty and frailty was 60.7% and 10.6%, respectively. Pre-frailty and frailty were associated with a higher risk of unplanned hospitalizations [adjusted hazard ratio (aHR) 1.82, 95% confidence interval (CI) 1.49-2.22; P < 0.001; and aHR 3.59, 95% CI 2.78-4.63, P < 0.001], all-cause mortality (aHR 5.07, 95% CI 2.43-10.59; P < 0.001; and aHR 16.72, 95% CI 7.75-36.05; P < 0.001), and bleeding (aHR 1.53, 95% CI 1.11-2.13; P = 0.01; and aHR 2.46, 95% CI 1.61-3.77; P < 0.001). Frailty, but not pre-frailty, was associated with a higher risk of stroke (aHR 3.29, 95% CI 1.2-8.39; P = 0.01). CONCLUSION: Over two-thirds of patients with AF are pre-frail or frail. These patients have a high risk for unplanned hospitalizations and other adverse events. These findings emphasize the need to carefully evaluate these patients. However, whether screening for pre-frailty and frailty and targeted prevention strategies improve outcomes needs to be shown in future studies. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov identifier number: NCT02105844.
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Gugganig et al. (2020) conducted a cohort in Atrial fibrillation (n=2,369). Frailty vs. Non-frail was evaluated on unplanned hospitalization (aHR 3.59, 95% CI 2.78-4.63, p=< 0.001). Frailty and pre-frailty in patients with atrial fibrillation were associated with a higher risk of unplanned hospitalizations.
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