Key result
In patients aged 60 and older with atrial fibrillation receiving anticoagulants, frailty syndromes such as severe physical activity restrictions independently predicted the risk of ischemic stroke and systemic embolism (HR 2.5).
Why the study?
Despite anticoagulant therapy, the annual incidence of ischemic stroke remains 2.5–4.5% per year, and factors determining this residual risk in elderly patients are actively studied.
What are the clinical and geriatric predictors of ischemic stroke, transient ischemic attack, and systemic embolism in elderly patients (≥60 years) with atrial fibrillation who are receiving anticoagulant therapy?
Cohort (n=600)
No
What are the clinical and geriatric predictors of ischemic stroke, transient ischemic attack, and systemic embolism in elderly patients (≥60 years) with atrial fibrillation who are receiving anticoagulant therapy?
Frailty syndromes, along with traditional risk factors, anemia, and uncontrolled blood pressure and cholesterol, are independent predictors of thromboembolic events in elderly patients with atrial fibrillation receiving anticoagulants.
Frailty syndromes were associated with higher residual stroke risk in anticoagulated older AF patients; hypothesis-generating and should not yet change practice.
Background. Despite anticoagulant therapy (AT), the annual incidence of ischemic stroke (IS) remains 2.5–4.5% per year. The factors determining the residual risk are currently being actively studied. The prognosis of elderly patients is influenced by the frailty syndromes. Aim. Based on prospective follow-up data, the frequency and predictors of IS / transient ischemic attack (TIA) / systemic embolism (SE) were determined in patients with atrial fibrillation over 60 years on AT. Materials and methods. 600 patients from the REGATTA-2 registry were included. We used the questionnaire „Age is not a hindrance“ to study frailty. Results. Frequency of the combined endpoint in all cohort was 3.7 per 100 patient-years. According to the Cox proportional hazards model, independent predictors of the development of IS/TIA/SE in patients receiving AT were: female gender [Hazard ratio (HR) 1.6], arterial hypertension (HR 6.1), history of IS/TIA/SE (HR 1.6), anemia (HR 1.9), failure to achieve target blood pressure levels (HR 2.2) and cholesterol (HR 2.6), cognitive impairment (HR 2.3), emotional disorders (HR 1.6) and severe physical activity restrictions (HR 2.5). Conclusion. Currently, it is advisable to introduce geriatric tools into the system of stratification of residual risk in elderly and senile atrial fibrillation patients.
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Kropacheva et al. (2026) conducted a cohort in Atrial fibrillation (n=600). Severe physical activity restrictions (frailty syndrome) vs. Absence of severe physical activity restrictions was evaluated on Ischemic stroke, transient ischemic attack, or systemic embolism (HR 2.5, 95% CI 1.5385-4.0834, p=0.0002). In patients aged 60 and older with atrial fibrillation receiving anticoagulants, frailty syndromes such as severe physical activity restrictions independently predicted the risk of ischemic stroke and systemic embolism (HR 2.5).
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