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

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

doi:10.1093/ageing/afac192

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

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

University of Liverpool
University of Milan
Molecular Cardiology and Medicine Division, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
University of Rome La Sapienza
University of Modena and Reggio Emilia
Aalborg University
Centre Hospitalier Régional Universitaire de Tours
Hospital Virgen de la Arrixaca
Ludwig Maximilian University of Munich
University of Belgrade
Clinical Center of Serbia
Carol Davila University of Medicine and Pharmacy
ANMCO Research Centre, Firenze, Italy
International Centre for Rural Health of the San Paolo Hospital
Istituti Clinici Scientifici Maugeri, IRCCS, Milan, Italy
Hôpital Trousseau, CHU de Tours
Associazione Nazionale Medici Cardiologi Ospedalieri

Research output: Contribution to journal › Article › Academic › 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
DOIs	https://doi.org/10.1093/ageing/afac192
Publication status	Published - 2022

Keywords

atrial fibrillation
chronicity
epidemiology
frailty
older people
oral anticoagulant therapy
outcomes

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10.1093/ageing/afac192

Epidemiology-and-impact-of-frailty-in-patients-with-atrial-fibrillation-in-europe.pdfFinal published version, 585 KB

Cite this

@article{6cff86d0b19e4d8b874124dfebcb3a2e,

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 = "atrial fibrillation, chronicity, epidemiology, frailty, older people, oral anticoagulant therapy, outcomes",

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 E. Z{\"e}ra and U. Ekmek{\c c}iu and V. Paparisto and M. Tase and H. Gjergo and J. Dragoti and A. Goda and M. Ciutea and N. Ahadi and \{el Husseini\}, Z. and M. Raepers and J. Leroy and P. Haushan and A. Jourdan and C. Lepiece and L. Desteghe and J. Vijgen and P. Koopman and \{van Genechten\}, G. and H. Heidbuchel and T. Boussy and \{de Coninck\}, M. and \{van Eeckhoutte\}, H. and N. Bouckaert and A. Friart and J. Boreux and C. Arend and P. Evrard and L. Stefan and E. Hoffer and J. Herzet and M. Massoz and C. Celentano and M. Sprynger and L. Pierard and P. Melon and \{van Hauwaert\}, B. and C. Kuppens and D. 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Jeewooth and B. Maria and C. Georgiana and C. Natalia and D. Alin and D. Dinu-Andrei and M. Livia and R. Daniela and R. Larisa and S. Umaar and T. Tamara and \{Ioachim Popescu\}, M. and D. Nistor and I. Sus and O. Coborosanu and N. Alina-Ramona and R. Dan and L. Petrescu and G. Ionescu and C. Vacarescu and E. Goanta and M. Mangea and A. Ionac and C. Mornos and D. Cozma and S. Pescariu and E. Solodovnicova and I. Soldatova and J. Shutova and L. Tjuleneva and T. Zubova and V. Uskov and D. Obukhov and G. Rusanova and S. Odinsova and T. Arhipova and E. Kazakevich and E. Serdechnaya and O. Zavyalova and T. Novikova and I. Riabaia and S. Zhigalov and E. Drozdova and I. Luchkina and Y. Monogarova and D. Hegya and L. Rodionova and V. Nevzorova and O. Lusanova and A. Arandjelovic and D. Toncev and M. Milanov and N. Sekularac and M. Zdravkovic and S. Hinic and S. Dimkovic and T. Acimovic and J. Saric and M. Polovina and T. Potpara and B. Vujisic-Tesic and M. Nedeljkovic and M. Zlatar and M. Asanin and V. Vasic and Z. Popovic and D. Djikic and M. Sipic and V. Peric and B. Dejanovic and N. Milosevic and A. Stevanovic and A. Andric and B. Pencic and M. Pavlovic-Kleut and V. Celic and M. Pavlovic and M. Petrovic and M. Vuleta and N. Petrovic and S. Simovic and Z. Savovic and S. Milanov and G. Davidovic and V. Iric-Cupic and D. Simonovic and M. Stojanovic and S. Stojanovic and V. Mitic and V. Ilic and D. Petrovic and \{Deljanin Ilic\}, M. and S. Ilic and V. Stoickov and S. Markovic and S. Kovacevic and \{Garc{\'i}a Fernandez\}, A. and \{Perez Cabeza\}, A. and M. Anguita and \{Tercedor Sanchez\}, L. and E. Mau and J. Loayssa and M. Ayarra and M. Carpintero and \{Rold{\'a}n Rabadan\}, I. and \{Gil Ortega\}, M. and \{Tello Montoliu\}, A. and \{Orenes Pi{\~n}ero\}, E. and \{Manzano Fern{\'a}ndez\}, S. and F. Mar{\'i}n and \{Romero Aniorte\}, A. and \{Veliz Mart{\'i}nez\}, A. and \{Quintana Giner\}, M. and G. Ballesteros and M. Palacio and O. Alcalde and I. Garc{\'i}a-Bolao and \{Bertomeu Gonzalez\}, V. and F. Otero-Ravi{\~n}a and \{Garc{\'i}a Seara\}, J. and \{Gonzalez Juanatey\}, J. and N. Dayal and P. Maziarski and P. Gentil-Baron and D. Shah and M. Ko{\c c} and E. Onrat and Dural, \{I. E.\} and K. Yilmaz and B. {\"O}zin and \{Tan Kurklu\}, S. and Y. Atmaca and U. Canpolat and L. Tokgozoglu and Dolu, \{A. K.\} and B. Demirtas and D. Sahin and \{Ozcan Celebi\}, O. and E. Diker and G. Gagirci and Turk, \{U. O.\} and H. Ari and N. Polat and N. Toprak and M. Sucu and \{Akin Serdar\}, O. and \{Taha Alper\}, A. and A. Kepez and Y. Yuksel and A. Uzunselvi and S. Yuksel and M. Sahin and O. Kayapinar and T. Ozcan and H. Kaya and Yilmaz, \{M. B.\} and M. Kutlu and M. Demir and C. Gibbs and S. Kaminskiene and M. Bryce and A. Skinner and G. Belcher and J. Hunt and L. Stancombe and B. Holbrook and C. Peters and S. Tettersell and A. Shantsila and D. Lane and K. Senoo and M. Proietti and K. Russell and P. Domingos and S. Hussain and J. Partridge and R. Haynes and S. Bahadur and R. Brown and S. McMahon and Lip, \{G. Y. H.\} and J. McDonald and K. Balachandran and R. Singh and S. Garg and H. Desai and K. Davies and W. Goddard and G. Galasko and I. Rahman and Y. Chua and O. Payne and S. Preston and O. Brennan and L. Pedley and C. Whiteside and C. Dickinson and J. Brown and K. Jones and L. Benham and R. Brady and L. Buchanan and A. Ashton and H. Crowther and H. Fairlamb and S. Thornthwaite and C. Relph and A. McSkeane and U. Poultney and N. Kelsall and P. Rice and T. Wilson and M. Wrigley and R. Kaba and T. Patel and E. Young and J. Law and C. Runnett and H. Thomas and H. McKie and J. Fuller and S. Pick and A. Sharp and A. Hunt and K. Thorpe and C. Hardman and E. Cusack and L. Adams and M. Hough and S. Keenan and A. Bowring and J. Watts and J. Zaman and K. Goffin and H. Nutt and Y. Beerachee and J. Featherstone and C. Mills and J. Pearson and L. Stephenson and S. Grant and A. Wilson and C. Hawksworth and I. Alam and M. Robinson and S. Ryan and R. Egdell and E. Gibson and M. Holland and D. Leonard and B. Mishra and S. Ahmad and H. Randall and J. Hill and L. Reid and M. George and S. McKinley and L. Brockway and W. Milligan and J. Sobolewska and J. Muir and L. Tuckis and L. Winstanley and P. Jacob and S. Kaye and L. Morby and A. Jan and T. Sewell and C. Boos and B. Wadams and C. Cope and P. Jefferey and N. Andrews and A. Getty and A. Suttling and C. Turner and K. Hudson and R. Austin and S. Howe and R. Iqbal and N. Gandhi and K. Brophy and P. Mirza and E. Willard and S. Collins and N. Ndlovu and E. Subkovas and V. Karthikeyan and L. Waggett and A. Wood and A. Bolger and J. Stockport and L. Evans and E. Harman and J. Starling and L. Williams and V. Saul and M. Sinha and L. Bell and S. Tudgay and S. Kemp and L. Frost and T. Ingram and A. Loughlin and C. Adams and M. Adams and F. Hurford and C. Owen and C. Miller and D. Donaldson and H. Tivenan and H. Button and A. Nasser and O. Jhagra and B. Stidolph and C. Brown and C. Livingstone and M. Duffy and P. Madgwick and P. Roberts and E. Greenwood and L. Fletcher and M. Beveridge and S. Earles and D. McKenzie and D. Beacock and M. Dayer and M. Seddon and D. Greenwell and F. Luxton and F. Venn and H. Mills and J. Rewbury and K. James and K. Roberts and L. Tonks and D. Felmeden and W. Taggu and A. Summerhayes and D. Hughes and J. Sutton and L. Felmeden and M. Khan and E. Walker and L. Norris and L. O{\textquoteright}Donohoe and A. Mozid and H. Dymond and H. Lloyd-Jones and G. Saunders and D. Simmons and D. Coles and D. Cotterill and S. Beech and S. Kidd and B. Wrigley and S. Petkar and A. Smallwood and R. Jones and E. Radford and S. Milgate and S. Metherell and V. Cottam and \{The ESC-EHRA EORP-AF General Long-Term Registry Investigators\} and C. Buckley and A. Broadley and D. Wood and J. Allison and K. Rennie and L. Balian and L. Howard and L. Pippard and S. Board and T. Pitt-Kerby",

year = "2022",

doi = "10.1093/ageing/afac192",

language = "English",

volume = "51",

journal = "Age and ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

number = "8",

}

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 - Zëra, E.

AU - Ekmekçiu, U.

AU - Paparisto, V.

AU - Tase, M.

AU - Gjergo, H.

AU - Dragoti, J.

AU - Goda, A.

AU - Ciutea, M.

AU - Ahadi, N.

AU - el Husseini, Z.

AU - Raepers, M.

AU - Leroy, J.

AU - Haushan, P.

AU - Jourdan, A.

AU - Lepiece, C.

AU - Desteghe, L.

AU - Vijgen, J.

AU - Koopman, P.

AU - van Genechten, G.

AU - Heidbuchel, H.

AU - Boussy, T.

AU - de Coninck, M.

AU - van Eeckhoutte, H.

AU - Bouckaert, N.

AU - Friart, A.

AU - Boreux, J.

AU - Arend, C.

AU - Evrard, P.

AU - Stefan, L.

AU - Hoffer, E.

AU - Herzet, J.

AU - Massoz, M.

AU - Celentano, C.

AU - Sprynger, M.

AU - Pierard, L.

AU - Melon, P.

AU - van Hauwaert, B.

AU - Kuppens, C.

AU - Faes, D.

AU - van Lier, D.

AU - van Dorpe, A.

AU - Gerardy, A.

AU - Deceuninck, O.

AU - Xhaet, O.

AU - Dormal, F.

AU - Ballant, E.

AU - Blommaert, D.

AU - Yakova, D.

AU - Hristov, M.

AU - Yncheva, T.

AU - Stancheva, N.

AU - Tisheva, S.

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AU - Sutton, J.

AU - Felmeden, L.

AU - Khan, M.

AU - Walker, E.

AU - Norris, L.

AU - O’Donohoe, L.

AU - Mozid, A.

AU - Dymond, H.

AU - Lloyd-Jones, H.

AU - Saunders, G.

AU - Simmons, D.

AU - Coles, D.

AU - Cotterill, D.

AU - Beech, S.

AU - Kidd, S.

AU - Wrigley, B.

AU - Petkar, S.

AU - Smallwood, A.

AU - Jones, R.

AU - Radford, E.

AU - Milgate, S.

AU - Metherell, S.

AU - Cottam, V.

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

AU - Buckley, C.

AU - Broadley, A.

AU - Wood, D.

AU - Allison, J.

AU - Rennie, K.

AU - Balian, L.

AU - Howard, L.

AU - Pippard, L.

AU - Board, S.

AU - Pitt-Kerby, T.

PY - 2022

Y1 - 2022

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 - atrial fibrillation

KW - chronicity

KW - epidemiology

KW - frailty

KW - older people

KW - oral anticoagulant therapy

KW - outcomes

UR - https://www.scopus.com/pages/publications/85136218862

U2 - 10.1093/ageing/afac192

DO - 10.1093/ageing/afac192

M3 - 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

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