Key result
Frailty in older AF patients is linked to ~34% higher homocysteine and increased 180-day readmissions.
Why the study?
Clinical factors associated with frailty and its impact on short-term outcomes in older hospitalized patients with atrial fibrillation were not well characterized.
Does frailty status predict 180-day all-cause readmission and what clinical factors are associated with frailty in older hospitalized patients with atrial fibrillation?
Cohort (n=198)
No
Does frailty status predict 180-day all-cause readmission and what clinical factors are associated with frailty in older hospitalized patients with atrial fibrillation?
Odds Ratio: 1.34 (95% CI 1.09–1.65)
p-value: p=0.006
In older hospitalized patients with atrial fibrillation, clinical frailty is associated with higher homocysteine and C-reactive protein levels, and it independently predicts a significantly increased hazard of 180-day all-cause readmission.
May support frailty screening to stratify 180-day readmission risk in older AF patients; leaves open whether interventions modify outcomes.
To examine clinical factors associated with frailty and evaluate short-term outcomes among older hospitalized patients with atrial fibrillation (AF). This single-center retrospective cohort study included 198 patients aged ≥ 60 years with documented AF who were hospitalized between January 2018 and December 2024. According to the FRAIL scale, 28 patients were classified as robust, 68 as pre-frail, and 102 as frail. Demographic characteristics, AF-related features, medications and management strategies, laboratory and echocardiographic parameters, functional and cognitive performance, and nutritional risk were compared across frailty categories. Univariable and multivariable logistic regression analyses were used to examine factors associated with frailty. Time to first all-cause readmission within 180 days was evaluated using Kaplan–Meier and Cox proportional hazards analyses. Known AF duration, multimorbidity, polypharmacy, functional impairment, cognitive impairment, nutritional risk, homocysteine, and C-reactive protein differed across frailty categories. In the multivariable model, higher homocysteine levels (adjusted OR per 5-μmol/L increase, 1.34; 95% CI 1.09–1.65), higher C-reactive protein levels (adjusted OR per 5-mg/L increase, 1.15; 95% CI 1.02–1.31), lower Montreal Cognitive Assessment scores (adjusted OR per 1-point increase, 0.63; 95% CI 0.49–0.81), and higher Nutritional Risk Screening 2002 scores (adjusted OR per 1-point increase, 2.28; 95% CI 1.58–3.28) were independently associated with frailty. Readmission within 90 days did not differ significantly among groups, whereas 180-day readmission occurred in 3.7% of robust, 4.6% of pre-frail, and 20.4% of frail patients ( P = 0.004). Each 1-point increase in FRAIL score was associated with a higher adjusted hazard of first readmission (HR, 1.53; 95% CI 1.14–2.05). In this small exploratory cohort, frailty was associated with higher homocysteine and C-reactive protein levels, poorer cognitive performance, greater nutritional risk, and a higher risk of first all-cause readmission within 180 days. Larger prospective studies are needed to confirm these findings.
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Ren et al. (2026) conducted a cohort in Atrial fibrillation (n=198). Homocysteine (per 5-μmol/L increase) vs. Lower homocysteine levels was evaluated on Frailty status at index admission (FRAIL score ≥ 3) (OR 1.34, 95% CI 1.09-1.65, p=0.006). Frailty in older patients with atrial fibrillation was independently associated with higher homocysteine (OR 1.34), higher C-reactive protein (OR 1.15), and nutritional risk, and predicted higher 180-day readmission risk (HR 1.53).
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