Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Age Ageing. 2022 Aug 2;51(8). doi: 10.1093/ageing/afac192.
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.
We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.
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.
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.
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.
衰弱是一种以生理储备减少和对压力源易感性增加为特征的医学综合征。关于衰弱与心房颤动（AF）之间关系的数据仍然不一致。
我们旨在对大型欧洲 AF 患者队列进行全面的衰弱评估。
根据 ESC-EHRA EORP-AF 一般长期注册研究中纳入的 AF 患者的累积缺陷模型，构建了一个包含 40 个项目的衰弱指数（FI）。检查基线特征、临床管理、生活质量、医疗资源使用和结局风险与衰弱之间的关联。
在 10177 名患者中（平均年龄（标准差）69.0（11.4）岁，4103 名[40.3%]为女性），6066 名（59.6%）为虚弱前期，2172 名（21.3%）为衰弱，而只有 1939 名（19.1%）被认为是健壮的。基线血栓栓塞和出血风险与 FI 增加独立相关。患有 AF 的衰弱患者接受口服抗凝剂（OAC）治疗的可能性较低（比值比 0.70，95%置信区间 0.55-0.89），尤其是与非维生素 K 拮抗剂 OAC 治疗且采用节律控制策略的患者。与健壮患者相比，衰弱程度增加与所有检查结果的风险增加呈非线性指数关系。OAC 的使用与除了非常高/极高衰弱的患者外，与结局风险降低相关。
在这个大型 AF 患者队列中，衰弱的负担很高，影响临床管理和不良结局的风险。在高衰弱患者中，OAC 的临床获益是维持的，但在非常高/极高衰弱患者中则不然。
