Frailty to predict unplanned hospitalization, stroke, bleeding and death in atrial fibrillation.

Gugganig, Rebecca; Aeschbacher, Stefanie; Leong, Darryl P; Meyre, Pascal; Blum, Steffen; Coslovsky, Michael; Beer, Jürg H; Moschovitis, Giorgio; Müller, Dominic; Anker, Daniela; Rodondi, Nicolas; Stempfel, Samuel; Müller, Christian; Meyer-Zürn, Christine; Kühne, Michael; Conen, David; Osswald, Stefan (2020). Frailty to predict unplanned hospitalization, stroke, bleeding and death in atrial fibrillation. (In Press). European heart journal Oxford University Press 10.1093/ehjqcco/qcaa002

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AIMS Atrial fibrillation (AF) and frailty are common, and the prevalence is expected to rise further. We aimed to investigate the prevalence of frailty and the ability of a frailty index (FI) to predict unplanned hospitalizations, stroke, bleeding and death in patients with AF. METHODS AND RESULTS Patients with known AF were enrolled in a prospective cohort study in Switzerland. Information on medical history, lifestyle-factors and clinical measurements were obtained. The primary outcome was unplanned hospitalization; secondary outcomes were all-cause mortality, bleeding and stroke. The FI was measured using a cumulative deficit approach, constructed according to previously published criteria and divided into three groups (non-frail, pre-frail, frail). The association between frailty and outcomes was assessed using multivariable adjusted Cox regression models. Of the 2369 included patients, prevalence of pre-frailty and frailty was 60.7% and 10.6%, respectively. Pre-frailty and frailty were associated with a higher risk of unplanned hospitalizations (adjusted hazard ratio [aHR] 1.82; 95% confidence interval [CI], 1.49-2.22, p < 0.001; and aHR 3.59; 95%CI 2.78-4.63, p < 0.001), all-cause mortality (aHR 5.07; 95%CI 2.43-10.59, p < 0.001; and aHR 16.72; 95%CI 7.75-36.05, p < 0.001), and bleeding (aHR 1.53; 95%CI 1.11-2.13, p = 0.01; and aHR 2.46; 95%CI 1.61-3.77, p < 0.001). Frailty, but not pre-frailty was associated with a higher risk of stroke (aHR 3.29; 95%CI 1.29-8.39, p = 0.01). CONCLUSION Over two thirds of patients with AF are pre-frail or frail. These patients have a high risk for unplanned hospitalizations and other adverse events. These findings emphasize the need to carefully evaluate these patients. However, whether screening for pre-frailty and frailty and targeted prevention strategies improve outcomes needs to be shown in future studies.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Anker, Daniela and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1522-9645

Publisher:

Oxford University Press

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

10 Feb 2020 11:42

Last Modified:

13 Feb 2020 15:20

Publisher DOI:

10.1093/ehjqcco/qcaa002

PubMed ID:

31977016

Uncontrolled Keywords:

Atrial fibrillation elderly frailty hospitalization mortality

BORIS DOI:

10.7892/boris.139570

URI:

https://boris.unibe.ch/id/eprint/139570

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