Key result
Frailty is linked to ~271% higher risk of major events in AF patients on DOACs.
Why the study?
There is no report on the associations between frailty and clinical adverse events in patients with AF taking direct oral anticoagulants, and factors related to adverse events remain under discussion.
Does frailty increase the risk of adverse clinical events in patients with atrial fibrillation taking direct oral anticoagulants?
Cohort (n=240)
No
Does frailty increase the risk of adverse clinical events in patients with atrial fibrillation taking direct oral anticoagulants?
Frailty is a strong independent predictor of adverse clinical events, including death, stroke, and major bleeding, in patients with atrial fibrillation treated with DOACs.
May warrant frailty assessment in AF patients on DOACs; leaves open whether it should guide therapy or modify DOAC selection.
BACKGROUND: Frailty is a prognostic factor in patients with atrial fibrillation (AF). However, there is no report on the associations between frailty and clinical adverse events in patients with AF taking direct oral anticoagulants (DOAC). The factors related to the occurrence of clinical adverse events are still under discussion. Therefore, we examined the associations between frailty and clinical adverse events in patients with AF taking DOAC in daily clinical practice. METHODS: We retrospectively evaluated 240 consecutive patients with AF who had been newly prescribed DOAC in our hospital from April 2016 through May 2017. Data collected included Clinical Frailty Scale (CFS) scores, laboratory results and basic demographic information. RESULTS: During the mean follow-up period of 13.4 months, 20 patients died (7.6 per 100 person-years), stroke or systemic embolism occurred in seven patients (2.6 per 100 person-years) and major bleeding occurred in 11 patients (4.2 per 100 person-years). We defined these adverse events as composite end points, and we estimated adjusted HRs and 95% CIs for risk factors using the Cox proportional hazard regression model. Frailty (defined as a CFS score of 5 or more; HR: 3.71; 95% CI: 1.59 to 8.65), female sex (HR: 3.49; 95% CI: 1.73 to 7.07), serum albumin level (HR: 0.47; 95% CI: 0.28 to 0.79) and malignancy (HR: 4.02; 95% CI: 1.83 to 8.84) were independent predictors of the composite end points. CONCLUSIONS: Frailty, female sex, hypoalbuminaemia and malignancy were associated with clinical adverse events in patients with AF who were prescribed DOAC.
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Yamamoto et al. (2019) conducted a cohort in Atrial fibrillation (n=240). Frailty (Clinical Frailty Scale score ≥ 5) vs. Non-frail (Clinical Frailty Scale score 1-4) was evaluated on Composite of all-cause mortality, stroke or systemic embolism, and major bleeding (HR 3.71, 95% CI 1.59-8.65, p=0.002). Frailty was independently associated with a significantly increased risk of all-cause mortality, stroke, systemic embolism, or major bleeding (HR 3.71) in patients with atrial fibrillation taking DOACs.
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