Bul Mary, Shaikh Fahad, McDonagh Julee, Ferguson Caleb
Western Sydney University Parramatta New South Wales Australia.
Western Sydney Nursing and Midwifery Research Centre Western Sydney Local Health District and Western Sydney University, Blacktown Clinical and Research School, Blacktown Hospital Blacktown New South Wales Australia.
Aging Med (Milton). 2022 Jun 1;6(2):195-206. doi: 10.1002/agm2.12214. eCollection 2023 Jun.
The objectives of this study were to determine the prevalence of frailty in the context of atrial fibrillation (AF); to identify the most commonly used frailty instruments in AF; and to describe the effect of frailty on non-vitamin K oral anticoagulant (NOAC) prescription for stroke prevention in adults with AF.
A systematic search of databases, including Medline, Embase, Web of Science, Cochrane Library, Scopus, and CINAHL, was conducted using search terms including "atrial fibrillation," "frailty," and "anticoagulation." A narrative synthesis was undertaken.
A total of 92 articles were screened, and 12 articles were included. The mean age of the participants ( = 212,111) was 82 years (range = 77-85 years) with 56% of participants identified as frail and 44% identified non-frail. A total of five different frailty instruments were identified: the Frailty Phenotype (FP; = 5, 42%), the Clinical Frailty Scale (CFS; = 4, 33%), Cumulative Deficit Model of Frailty (CDM; = 1, 8%), Edmonton Frail Scale ( = 1, 8%) and the Resident Assessment Instrument - Minimum Data Set (RAI-MDS 2.0; = 1, 8%). Frailty was identified as an important barrier to anticoagulant therapy with 52% of the frail population anticoagulated vs 67% non-frail.
Frailty is an important consideration in anticoagulation decision making for stroke prevention in patients with AF. There is scope to improve frailty screening and treatment. Frailty status is an important risk marker and should be considered when evaluating stroke risk alongside congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke, transient ischemic attack, or thromboembolism, vascular disease, age 65-74 years, sex category (CHADS-VASc) and Hypertension, Abnormal renal/liver function, Stroke, Bleeding, Labile, Elderly, and Drugs (HAS-BLED) scores.
本研究的目的是确定心房颤动（AF）背景下衰弱的患病率；确定AF中最常用的衰弱评估工具；并描述衰弱对非维生素K口服抗凝剂（NOAC）用于AF成年患者预防卒中处方的影响。
使用包括“心房颤动”“衰弱”和“抗凝”等检索词，对包括Medline、Embase、Web of Science、Cochrane图书馆、Scopus和CINAHL在内的数据库进行系统检索。进行叙述性综述。
共筛选92篇文章，纳入12篇文章。参与者（n = 212,111）的平均年龄为82岁（范围 = 77 - 85岁），其中56%的参与者被确定为衰弱，44%被确定为非衰弱。共确定了五种不同的衰弱评估工具：衰弱表型（FP；n = 5，42%）、临床衰弱量表（CFS；n = 4，33%）、累积衰弱缺陷模型（CDM；n = 1，8%）、埃德蒙顿衰弱量表（n = 1，8%）和居民评估工具 - 最低数据集（RAI - MDS 2.0；n = 1，8%）。衰弱被确定为抗凝治疗的一个重要障碍，52%的衰弱人群接受抗凝治疗，而非衰弱人群为67%。
衰弱是AF患者预防卒中抗凝决策中的一个重要考虑因素。改善衰弱筛查和治疗仍有空间。衰弱状态是一个重要的风险标志物，在评估卒中风险时，应与充血性心力衰竭、高血压、年龄≥75岁、糖尿病、既往卒中、短暂性脑缺血发作或血栓栓塞、血管疾病、年龄65 - 74岁、性别类别（CHADS - VASc）以及高血压、异常肾/肝功能、卒中、出血、不稳定、老年和药物（HAS - BLED）评分一起考虑。
