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 S Potpara; Gheorghe-Andrei Dan; Aldo P Maggioni; Matteo Cesari; Giuseppe Boriani; Gregory Y H Lip; ESC-EHRA EORP-AF General Long-Term Registry Investigators; Albert Marni Joensen; Anders Gammelmark; Lars Hvilsted Rasmussen; Pia Danstrup-Dinesen; Sam Riahi; Stine Krogh Venø; Bodil Ginnerup Sørensen; Anne Marie Korsgaard; Karen Petrea  Andersen; Camilla Fragtrup Hellum

doi:10.1093/ageing/afac192

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 S Potpara, Gheorghe-Andrei Dan, Aldo P Maggioni, Matteo Cesari, Giuseppe Boriani, Gregory Y H Lip, ESC-EHRA EORP-AF General Long-Term Registry Investigators , Albert Marni Joensen (Member of study group), Anders Gammelmark (Member of study group), Lars Hvilsted Rasmussen (Member of study group), Pia Danstrup-Dinesen (Member of study group), Sam Riahi (Member of study group)Stine Krogh Venø (Member of study group), Bodil Ginnerup Sørensen (Member of study group), Anne Marie Korsgaard (Member of study group), Karen Petrea Andersen (Member of study group), Camilla Fragtrup Hellum (Member of study group)

Research output: Contribution to journal › Journal article › Research › peer-review

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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.

Original language	English
Article number	afac192
Journal	Age and Ageing
Volume	51
Issue number	8
ISSN	0002-0729
DOIs	https://doi.org/10.1093/ageing/afac192
Publication status	Published - 2 Aug 2022

Bibliographical note

Keywords

Administration, Oral
Aged
Anticoagulants/adverse effects
Atrial Fibrillation/diagnosis
Europe/epidemiology
Female
Frailty/chemically induced
Humans
Male
Quality of Life
Registries
Risk Factors
Stroke/complications
oral anticoagulant therapy
chronicity
epidemiology
frailty
atrial fibrillation
outcomes
older people

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https://academic.oup.com/ageing/article/51/8/afac192/6670566

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Proietti, M., Romiti, G. F., Vitolo, M., Harrison, S. L., Lane, D. A., Fauchier, L., Marin, F., Näbauer, M., Potpara, T. S., Dan, G.-A., Maggioni, A. P., Cesari, M., Boriani, G., Lip, G. Y. H., ESC-EHRA EORP-AF General Long-Term Registry Investigators , Joensen, A. M., Gammelmark, A., Rasmussen, L. H., Danstrup-Dinesen, P., ... Hellum, C. F. (2022). Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age and Ageing, 51(8), Article afac192. https://doi.org/10.1093/ageing/afac192

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title = "Epidemiology and impact of frailty in patients with atrial fibrillation in Europe",

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.",

keywords = "Administration, Oral, Aged, Anticoagulants/adverse effects, Atrial Fibrillation/diagnosis, Europe/epidemiology, Female, Frailty/chemically induced, Humans, Male, Quality of Life, Registries, Risk Factors, Stroke/complications, oral anticoagulant therapy, chronicity, epidemiology, frailty, atrial fibrillation, outcomes, older people",

author = "Marco Proietti and Romiti, {Giulio Francesco} and Marco Vitolo and Harrison, {Stephanie L} and Lane, {Deirdre A} and Laurent Fauchier and Francisco Marin and Michael N{\"a}bauer and Potpara, {Tatjana S} and Gheorghe-Andrei Dan and Maggioni, {Aldo P} and Matteo Cesari and Giuseppe Boriani and Lip, {Gregory Y H} and {ESC-EHRA EORP-AF General Long-Term Registry Investigators} and Joensen, {Albert Marni} and Anders Gammelmark and Rasmussen, {Lars Hvilsted} and Pia Danstrup-Dinesen and Sam Riahi and Ven{\o}, {Stine Krogh} and S{\o}rensen, {Bodil Ginnerup} and Korsgaard, {Anne Marie} and Andersen, {Karen Petrea} and Hellum, {Camilla Fragtrup}",

year = "2022",

month = aug,

day = "2",

doi = "10.1093/ageing/afac192",

language = "English",

volume = "51",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

number = "8",

}

Proietti, M, Romiti, GF, Vitolo, M, Harrison, SL, Lane, DA, Fauchier, L, Marin, F, Näbauer, M, Potpara, TS, Dan, G-A, Maggioni, AP, Cesari, M, Boriani, G, Lip, GYH, ESC-EHRA EORP-AF General Long-Term Registry Investigators , Joensen, AM , Gammelmark, A , Rasmussen, LH , Danstrup-Dinesen, P , Riahi, S , Venø, SK, Sørensen, BG, Korsgaard, AM, Andersen , KP & Hellum, CF 2022, 'Epidemiology and impact of frailty in patients with atrial fibrillation in Europe', Age and Ageing, vol. 51, no. 8, afac192. https://doi.org/10.1093/ageing/afac192

TY - JOUR

T1 - Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

AU - Proietti, Marco

AU - Romiti, Giulio Francesco

AU - Vitolo, Marco

AU - Harrison, Stephanie L

AU - Lane, Deirdre A

AU - Fauchier, Laurent

AU - Marin, Francisco

AU - Näbauer, Michael

AU - Potpara, Tatjana S

AU - Dan, Gheorghe-Andrei

AU - Maggioni, Aldo P

AU - Cesari, Matteo

AU - Boriani, Giuseppe

AU - Lip, Gregory Y H

AU - ESC-EHRA EORP-AF General Long-Term Registry Investigators

A2 - Joensen, Albert Marni

A2 - Gammelmark, Anders

A2 - Rasmussen, Lars Hvilsted

A2 - Danstrup-Dinesen, Pia

A2 - Riahi, Sam

A2 - Venø, Stine Krogh

A2 - Sørensen, Bodil Ginnerup

A2 - Korsgaard, Anne Marie

A2 - Andersen , Karen Petrea

A2 - Hellum, Camilla Fragtrup

PY - 2022/8/2

Y1 - 2022/8/2

N2 - 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.

AB - 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.

KW - Administration, Oral

KW - Aged

KW - Anticoagulants/adverse effects

KW - Atrial Fibrillation/diagnosis

KW - Europe/epidemiology

KW - Female

KW - Frailty/chemically induced

KW - Humans

KW - Male

KW - Quality of Life

KW - Registries

KW - Risk Factors

KW - Stroke/complications

KW - oral anticoagulant therapy

KW - chronicity

KW - epidemiology

KW - frailty

KW - atrial fibrillation

KW - outcomes

KW - older people

UR - http://www.scopus.com/inward/record.url?scp=85136218862&partnerID=8YFLogxK

U2 - 10.1093/ageing/afac192

DO - 10.1093/ageing/afac192

M3 - Journal article

C2 - 35997262

SN - 0002-0729

VL - 51

JO - Age and Ageing

JF - Age and Ageing

IS - 8

M1 - afac192

ER -

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

Abstract

Bibliographical note

Keywords

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