Yao Jianhong, Chen Ke, He Zhifen, Chen Dan
Jianhong Yao, Department of Geriatric, Huzhou Third Municipal Hospital, Affiliated Hospital of Huzhou University, Huzhou, Zhejiang Province 313000, P.R. China.
Ke Chen, Department of Geriatric Psychiatry, Huzhou Third Municipal Hospital, Affiliated Hospital of Huzhou University, Huzhou, Zhejiang Province 313000, P.R. China.
Pak J Med Sci. 2025 Mar;41(3):891-901. doi: 10.12669/pjms.41.3.11357.
Atrial fibrillation (AF) prevalences have risen globally due to the increasing aging populations posing significant health challenges. Frailty, a state characterized by weak physiological reserves, has emerged as a crucial factor influencing cardiovascular disease outcomes, including those in patients with AF. With this systematic review and meta-analysis, we aimed to elucidate the impact of frailty on mortality, and the incidences of stroke, major bleeding events, and other outcomes in elderly patients with AF.
A comprehensive search of PubMed, EMBASE, and Scopus databases yielded 1302 relevant records from inception until January 2024. We screened them to assess their eligibility for our study. We included data from 23 studies into our analysis, covering a diverse global population. We also assessed the quality of the included studies by assigning Newcastle- Ottawa Scale scores.
Frailty demonstrated a consistent association with increased all-cause mortality (Hazards ratio [HR] 2.46 in frail individuals). Frailty also correlated with elevated risks of stroke (HR, 1.46) and major bleeding events (HR, 1.34). Our analysis also revealed non-significant associations with cardiovascular death and intra-cranial hemorrhage.
Frailty significantly increases the frequency of adverse outcomes in elderly patients with AF; thus, these patients should be managed with tailored risk stratification tools. Integrating frailty assessments into clinical decision-making should aid in optimizing care strategies and enhance outcomes in this vulnerable population.
由于全球人口老龄化加剧，心房颤动（AF）的患病率不断上升，这带来了重大的健康挑战。衰弱是一种以生理储备薄弱为特征的状态，已成为影响心血管疾病结局（包括AF患者）的关键因素。通过这项系统评价和荟萃分析，我们旨在阐明衰弱对老年AF患者死亡率、中风发生率、重大出血事件及其他结局的影响。
对PubMed、EMBASE和Scopus数据库进行全面检索，从建库至2024年1月共获得1302条相关记录。我们对这些记录进行筛选，以评估其是否符合我们的研究要求。我们将23项研究的数据纳入分析，这些研究涵盖了不同的全球人群。我们还通过赋予纽卡斯尔-渥太华量表分数来评估纳入研究的质量。
衰弱与全因死亡率增加存在一致关联（衰弱个体的风险比[HR]为2.46）。衰弱还与中风风险升高（HR，1.46）和重大出血事件风险升高（HR，1.34）相关。我们的分析还显示，衰弱与心血管死亡和颅内出血之间无显著关联。
衰弱显著增加老年AF患者不良结局的发生率；因此，应对这些患者使用量身定制的风险分层工具进行管理。将衰弱评估纳入临床决策应有助于优化护理策略并改善这一脆弱人群的结局。
