Key result
Frailty in elderly AF ablation patients is linked to ~2.1-fold higher in-hospital major adverse events.
Why the study?
Frailty is an important determinant of cardiovascular outcomes, but its impact on in-hospital and long-term outcomes after AF ablation in older patients was unclear.
Does frailty status (Hospital Frailty Risk Score) increase the risk of in-hospital major adverse events and long-term mortality or readmissions in patients aged ≥75 years undergoing atrial fibrillation ablation?
Cohort (n=2,865)
Yes
Does frailty status (Hospital Frailty Risk Score) increase the risk of in-hospital major adverse events and long-term mortality or readmissions in patients aged ≥75 years undergoing atrial fibrillation ablation?
In patients aged ≥75 years undergoing atrial fibrillation ablation, higher frailty scores strongly predict in-hospital major adverse events and long-term AF readmission, though they do not independently predict long-term all-cause mortality, heart failure admission, or stroke.
Frailty may flag higher periprocedural risk and AF readmission in older ablation patients; leaves open whether frailty assessment should guide selection or interventions.
Background Frailty is recognized as an important determinant of cardiovascular outcomes. However, its impact on in-hospital and long-term outcomes after atrial fibrillation (AF) ablation in older patients is unclear. Methods We conducted a retrospective observational cohort study of all consecutive patients aged ≥75 years undergoing AF ablation identified from the statewide Admitted Patient Data Collection (APDC) database (Mar 2004 and Mar 2021). Frailty status of each patient was derived from the AF ablation admission records using a validated Hospital Frailty Risk Score (HFRS) and analysed as a continuous variable. Endpoint include in-hospital major adverse events (MAE: defined as a composite of in-hospital death, permanent pacemaker or implantable cardioverter defibrillator implantation, ischaemic stroke/transient ischaemic attack [IS/TIA], or major bleeding) during the AF ablation admission. Long-term outcomes include: all-cause mortality and non-fatal outcomes encompassing AF readmission, heart failure (HF) or IS/TIA requiring admission during follow up. All-cause death and non-fatal outcomes requiring admission were tracked till Mar 2022 using linkage to the death registry and APDC database respectively. Multivariable logistic and Cox regression methods analysed frailty (HFRS) association with in-hospital MAE and all-cause death during follow up adjusted for age and sex respectively, while Fine-Gray competing risk of death assessed frailty association with non-fatal outcomes during follow up adjusted for age and sex. Results The cohort include 2865 patients (median age 79.5 [range: 75.0-97.6yrs]; 57% male). The mean (±SD) HFRS was 0.09±0.46 (median 0; range 0-7.1), with HFRS >0 in 141 patients (4.9%). In-hospital MAE was 4.6% and was associated with frailty (HFRS per-score: adjusted odds ratio [aOR] 2.1, 95% confidence interval [CI] 1.7-2.6, p<0.001); 2 patients died in-hospital. During a median follow-up of 4.4 years post AF ablation (interquartile range 2.4-7.1 years), 1020 patients (35.6%) died (female 32.4% vs male 38.0%, logrank p=0.011). Age (adjusted hazard ratio [aHR] 1.13 per-year, 95%CI 1.11-1.14, p<0.001) and male sex (aHR 1.26, 95%CI 1.11-1.43, p<0.001) independently predicted mortality, whereas frailty did not (aHR 1.09, 95%CI 0.95-1.21, p=0.292). For non-fatal long-term outcomes and accounting for death during follow up, frailty was associated with higher risk for AF readmission (HFRS per-score: adjusted subdistribution hazard ratio [adj.sHR] 1.19, 95%CI 1.05-1.35, p=0.009), but not for HF (adj.sHR 0.98, 95%CI 0.82-1.17, p=0.840) or IS/TIA (adj.sHR 1.05, 95%CI 0.81-1.37, p=0.700) admissions post AF ablation. Conclusions In patients aged ≥75 years undergoing AF ablation, frailty status was strongly associated with in-hospital MAE, and independently associated with higher risk of AF readmission but not with all-cause mortality, HF or stroke admission during long-term follow up.
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Altamimi et al. (2026) conducted a cohort in Atrial fibrillation (n=2,865). Frailty (Hospital Frailty Risk Score [HFRS] analyzed as a continuous variable) vs. Lower frailty score (per-score increase in HFRS) was evaluated on In-hospital major adverse events (composite of in-hospital death, permanent pacemaker or implantable cardioverter defibrillator implantation, ischaemic stroke/transient ischaemic attack, or major bleeding) (aOR 2.1, 95% CI 1.7-2.6, p=<0.001). Frailty (per HFRS score) in patients ≥75 years undergoing AF ablation increased in-hospital major adverse events (aOR 2.1; 95% CI 1.7-2.6) and AF readmission (adj.sHR 1.19), but not long-term mortality.
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