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 (2021). Frailty to predict unplanned hospitalization, stroke, bleeding and death in atrial fibrillation. European heart journal. Quality of care & clinical outcomes, 7(1), pp. 42-51. 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.

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