Park Jong Sung, Yang Pil-Sung, Kim Daehoon, Sung Jung-Hoon, Jang Eunsun, Yu Hee Tae, Kim Tae-Hoon, Pak Hui-Nam, Lee Moon-Hyoung, Joung Boyoung
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea.
Department of Cardiology, CHA Bundang Medical Center, CHA University, 13496 Seongnam, Republic of Korea.
Rev Cardiovasc Med. 2024 Jan 30;25(2):52. doi: 10.31083/j.rcm2502052. eCollection 2024 Feb.
Atrial fibrillation (AF) is an indicator of frailty in old patients. This study aimed to investigate the effect of frailty on the use of oral anticoagulants (OAC) and clinical outcomes in a nationwide cohort of patients with new-onset AF.
This study included 451,368 participants without AF from the Korea National Health Insurance Service-Health Screening cohort between 2002 and 2009. The Hospital Frailty Risk Score was retrospectively calculated for each patient using all available International Classification of Disease 10th revision diagnostic codes. According to the aggregate score, patients were divided into two groups: the participants without frailty ( 5 points) and the participants with frailty ( 5 points). The primary outcome was death from any cause, and the secondary outcomes were cardiovascular death, ischemic stroke, major bleeding, and heart failure admission.
With up to 7.2 1.5 years of follow-up, 11,953 participants (median age, 67 [interquartile range, 59.5-74.5] years; 7200 [60.2%] males) developed new-onset AF. Among the patients with AF, 3224 (26.9%) had frailty. Frailty was significantly associated with old age, female sex, polypharmacy, and other comorbidities. In patients with AF, frailty was negatively associated with OAC prescription after new-onset AF ( 0.001). Compared to patients without frailty, patients with frailty had a significantly higher incidence and risk of all-cause death (hazard ratio [HR] 2.88, 95% confidence interval [CI] 2.65-3.14), cardiovascular death (HR 2.42, 95% CI 2.10-2.80), ischemic stroke (HR 2.25, 95% CI 2.02-2.51), major bleeding (HR 2.44, 95% CI 2.17-2.73), and heart failure admission (HR 1.29, 95% CI 1.09-1.52). In subgroup analysis, when compared to the non-OAC group, the risks associated with frailty were significantly lower in the OAC group for all-cause death, cardiovascular death, ischemic stroke, and heart failure admission.
Frailty was negatively associated with the use of OAC and was a predictor of poor prognosis owing to the association of frailty with death, thromboembolic events, bleeding, and heart failure admission. However, OAC use was associated with lower risks related to frailty for all-cause death and major adverse cardiovascular events in patients with AF.
心房颤动（AF）是老年患者虚弱的一个指标。本研究旨在调查虚弱对全国范围内新发房颤患者口服抗凝药（OAC）使用及临床结局的影响。
本研究纳入了2002年至2009年间韩国国民健康保险服务健康筛查队列中451,368名无房颤的参与者。使用所有可用的国际疾病分类第10版诊断代码对每位患者进行回顾性计算医院虚弱风险评分。根据总分，患者分为两组：非虚弱参与者（≤5分）和虚弱参与者（＞5分）。主要结局是任何原因导致的死亡，次要结局是心血管死亡、缺血性卒中、大出血和心力衰竭住院。
随访长达7.2±1.5年，11,953名参与者（中位年龄67岁[四分位间距59.5 - 74.5岁]；7200名[60.2%]为男性）发生新发房颤。在房颤患者中，3224名（26.9%）存在虚弱。虚弱与老年、女性、多种药物治疗及其他合并症显著相关。在房颤患者中，虚弱与新发房颤后OAC处方呈负相关（P＜0.001）。与非虚弱患者相比，虚弱患者全因死亡（风险比[HR]2.88，95%置信区间[CI]2.65 - 3.14）、心血管死亡（HR 2.42，95% CI 2.10 - 2.80）、缺血性卒中（HR 2.25，95% CI 2.02 - 2.51）、大出血（HR 2.44，95% CI 2.17 - 2.73）及心力衰竭住院（HR 1.29，95% CI 1.09 - 1.52）的发生率及风险显著更高。在亚组分析中，与非OAC组相比，OAC组中虚弱相关的全因死亡、心血管死亡、缺血性卒中和心力衰竭住院风险显著更低。
虚弱与OAC使用呈负相关，且由于虚弱与死亡、血栓栓塞事件、出血及心力衰竭住院相关，故是预后不良的一个预测因素。然而，在房颤患者中，使用OAC与全因死亡及主要不良心血管事件相关的较低虚弱风险相关。
