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. 2021 Jan 25;7(1):42-51.
doi: 10.1093/ehjqcco/qcaa002.

Frailty to predict unplanned hospitalization, stroke, bleeding, and death in atrial fibrillation

Rebecca Gugganig  1   2 , Stefanie Aeschbacher  1   2 , Darryl P Leong  3 , Pascal Meyre  1   2 , Steffen Blum  1   2 , Michael Coslovsky  1   4 , Jürg H Beer  5 , Giorgio Moschovitis  6 , Dominic Müller  1 , Daniela Anker  7 , Nicolas Rodondi  7   8 , Samuel Stempfel  1   2 , Christian Mueller  1   2 , Christine Meyer-Zürn  1   2 , Michael Kühne  1   2 , David Conen  1   2   3 , Stefan Osswald  1   2 ; Swiss-AF Investigators
Affiliations
Free article

Frailty to predict unplanned hospitalization, stroke, bleeding, and death in atrial fibrillation

Rebecca Gugganig et al. Eur Heart J Qual Care Clin Outcomes. .
Free article

Abstract

Aims: Atrial fibrillation (AF) and frailty are common, and the prevalence is expected to rise further. We aimed to investigate the prevalence of frailty and the ability of a frailty index (FI) to predict unplanned hospitalizations, stroke, bleeding, and death in patients with AF.

Methods and results: Patients with known AF were enrolled in a prospective cohort study in Switzerland. Information on medical history, lifestyle factors, and clinical measurements were obtained. The primary outcome was unplanned hospitalization; secondary outcomes were all-cause mortality, bleeding, and stroke. The FI was measured using a cumulative deficit approach, constructed according to previously published criteria and divided into three groups (non-frail, pre-frail, and frail). The association between frailty and outcomes was assessed using multivariable-adjusted Cox regression models. Of the 2369 included patients, prevalence of pre-frailty and frailty was 60.7% and 10.6%, respectively. Pre-frailty and frailty were associated with a higher risk of unplanned hospitalizations [adjusted hazard ratio (aHR) 1.82, 95% confidence interval (CI) 1.49-2.22; P < 0.001; and aHR 3.59, 95% CI 2.78-4.63, P < 0.001], all-cause mortality (aHR 5.07, 95% CI 2.43-10.59; P < 0.001; and aHR 16.72, 95% CI 7.75-36.05; P < 0.001), and bleeding (aHR 1.53, 95% CI 1.11-2.13; P = 0.01; and aHR 2.46, 95% CI 1.61-3.77; P < 0.001). Frailty, but not pre-frailty, was associated with a higher risk of stroke (aHR 3.29, 95% CI 1.2-8.39; P = 0.01).

Conclusion: Over two-thirds of patients with AF are pre-frail or frail. These patients have a high risk for unplanned hospitalizations and other adverse events. These findings emphasize the need to carefully evaluate these patients. However, whether screening for pre-frailty and frailty and targeted prevention strategies improve outcomes needs to be shown in future studies.

Clinical trial registration: Clinicaltrials.gov identifier number: NCT02105844.

Keywords: Atrial fibrillation; Elderly; Frailty; Hospitalization; Mortality.

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