Key result
Multidimensional frailty is linked to ~79% higher 1-year death or rehospitalization risk in AF.
Why the study?
The prevalence of physical and multidimensional frailty and their prognostic impact on clinical outcomes in patients with atrial fibrillation is unclear.
Does multidimensional frailty compared to physical frailty better predict all-cause mortality or rehospitalization in older patients with atrial fibrillation?
Cohort (n=197)
Yes
Does multidimensional frailty compared to physical frailty better predict all-cause mortality or rehospitalization in older patients with atrial fibrillation?
Hazard Ratio: 1.79 (95% CI 1.1–2.9)
p-value: p=0.02
In older patients with atrial fibrillation, multidimensional frailty is more prevalent and initially a better predictor of 1-year mortality or rehospitalization than physical frailty, though its prognostic value is attenuated by other clinical confounders.
Multidimensional frailty may aid risk stratification in older AF patients; leaves open its independent value after full confounder adjustment.
BACKGROUND: the prevalence of physical and multidimensional frailty and their prognostic impact on clinical outcomes in patients with atrial fibrillation (AF) is unclear. OBJECTIVE: to evaluated frailty in a cohort of patients with AF according to different criteria, and studied the prevalence and its prognostic impact on clinical outcomes. METHODS: in this multicenter prospective cohort, 197 inpatients ≥ 65 years old with AF were recruited from September 2018 to April 2019.We used Fried Frailty phenotype (Fried) to assess physical frailty, and comprehensive geriatric assessment-frailty index (CGA-FI) to assess multidimensional frailty. The primary outcome was a composite of all-cause mortality or rehospitalization. RESULTS: the prevalence of frailty was determined as 34.5% by Fried, 42.6% by CGA-FI. Malnutrition and ≥ 7 medications were independently associated with frailty. Kaplan-Meier survival curve showed that the presence of frailty by CGA-FI had significantly lower all-cause mortality or rehospitalization survival rate (log-rank P = 0.04) within 1 year. Multivariate Cox regression adjusted for age and sex showed that the frailty by CGA-FI was significantly associated with the risk of all-cause mortality or rehospitalization within 1 year (HR 1.79, 95% CI 1.10-2.90). However, those associations were absent with the physical frailty. After broader multivariate adjustment, those associations were no longer statistically significant for both types of frailty. CONCLUSIONS: in older people with AF, Multidimensional frailty is more significantly associated with a composite of all-cause mortality or rehospitalization within 1 year than physical frailty, but these association are attenuated after multivariate adjustment. CLINICAL TRIAL REGISTRATION: ChiCTR1800017204; date of registration: 07/18/2018.
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Liu et al. (2023) conducted a cohort in Atrial fibrillation (n=197). Multidimensional frailty (CGA-FI) vs. Non-frail was evaluated on Composite of all-cause mortality or rehospitalization within 1 year (HR 1.79, 95% CI 1.10-2.90, p=0.02). In older people with atrial fibrillation, multidimensional frailty was significantly associated with an increased risk of all-cause mortality or rehospitalization within 1 year (HR 1.79) after adjusting for age and sex.
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