Epidemiology and impact of frailty in patients with atrial fibrillation in Europe
Marco Proietti, Giulio Francesco Romiti, Marco Vitolo, Stephanie L. Harrison, Deirdre A Lane, Laurent Fauchier, Francisco Marin, Michael Näbauer, Tatjana Potpara, Gheorghe‐Andrei Dan, Aldo P. Maggioni, Matteo Cesari, Giuseppe Boriani, Gregory Y H Lip, ESC-EHRA EORP-AF General Long-Term Registry Investigators, E Zëra, U Ekmekçiu, Vilma Paparisto, Mihal Tase, H Gjergo, J Dragoti, Artan Goda, M Ciutea, N. Ahadi, Ziad El Husseini, M. Raepers, J. Leroy, P Haushan, A Jourdan, Caroline Lepièce, Lien Desteghe, Johan Vijgen, Pieter Koopman, G. Van Genechten, Hein Heidbüchel, Tim Boussy, M De Coninck, Hannelore Van Eeckhoutte, N Bouckaert, Alain Friart, J. Boreux, C Arend, P Evrard, L Stefan, E Hoffer, J. Herzet, M Massoz, C. Celentano, Muriel Sprynger, Luc Piérard, P Mélon, B Van Hauwaert, C. Kuppens, Dirk Faes, Dirk van Lier, A. Van Dorpe, A. Gerardy, Olivier Deceuninck, Olivier Xhaët, Fabien Dormal, Elisabeth Ballant, Dominique Blommaert, D. Yakova, Mihail Hristov, T Yncheva, N. Stancheva, S. Tisheva, Mariya Tokmakova, Fedya Nikolov, D Gencheva, Tchavdar Shalganov, B. Kunev, M. Stoyanov, D. Marchov, Валери Гелев, Vassil Traykov, Аntoniya Kisheva, H Tsvyatkov, R Shtereva, S Bakalska-Georgieva, S Slavcheva, Yoto Yotov, Milena Kubíčková, A Marni Joensen, Anders Gammelmark, Lars Hvilsted Rasmussen, P Dinesen, Sam Riahi, Stine Krogh Venø, Birgit Sørensen, A. Korsgaard, Karl Andersen, Camilla Fragtrup Hellum, A Svenningsen, Ole Nyvad, P Wiggers, O May, Annemarie Aarup, B Graversen, Lisette Okkels Jensen
Abstract
BACKGROUND: Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES: We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS: A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS: Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS: In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.