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. 2023 Jan 6:9:1050744.
doi: 10.3389/fcvm.2022.1050744. eCollection 2022.

Impact of frailty on early rhythm control outcomes in older adults with atrial fibrillation: A nationwide cohort study

Ga-In Yu  1 , Daehoon Kim  1 , Jung-Hoon Sung  2 , Eunsun Jang  1 , Hee Tae Yu  1 , Tae-Hoon Kim  1 , Hui-Nam Pak  1 , Moon-Hyoung Lee  1 , Gregory Y H Lip  3 , Pil-Sung Yang  2 , Boyoung Joung  1
Affiliations

Impact of frailty on early rhythm control outcomes in older adults with atrial fibrillation: A nationwide cohort study

Ga-In Yu et al. Front Cardiovasc Med. .

Abstract

Purpose: Rhythm-control therapy administered early following the initial diagnosis of atrial fibrillation (AF) has superior cardiovascular outcomes compared to rate-control therapy. Frailty is a key factor in identifying older patients' potential for improvement after rhythm-control therapy. This study evaluated whether frailty affects the outcome of early rhythm-control therapy in older patients with AF.

Methods: From the Korean National Health Insurance Service database (2005-2015), we collected 20,611 populations aged ≥65 years undergoing rhythm- or rate-control therapy initiated within 1 year of AF diagnosis. Participants were emulated by the EAST-AFNET4 trial, and stratified into non-frail, moderately frail, and highly frail groups based on the hospital frailty risk score (HFRS). A composite outcome of cardiovascular-related mortality, myocardial infarction, hospitalization for heart failure, and ischemic stroke was compared between rhythm- and rate-control.

Results: Early rhythm-control strategy showed a 14% lower risk of the primary composite outcome in the non-frail group [weighted incidence 7.3 vs. 8.6 per 100 person-years; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.79-0.93, p < 0.001] than rate-control strategy. A consistent trend toward a lower risk of early rhythm-control was observed in the moderately frail (HR 0.91, 95% CI 0.81-1.02, p = 0.09) and highly frail (HR 0.93, 95% CI 0.75-1.17, p = 0.55) groups.

Conclusion: Although the degree attenuated with increasing frailty, the superiority of cardiovascular outcomes of early rhythm-control in AF treatment was maintained without increased risk for safety outcomes. An individualized approach is required on the benefits of early rhythm-control therapy in older patients with AF, regardless of their frailty status.

Keywords: atrial fibrillation; frailty; older adults; rate-control; rhythm-control.

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Conflict of interest statement

BJ has served as a speaker for Bayer, BMS/Pfizer, Medtronic, Johnson & Johnson, and Daiichi-Sankyo, and received research funds from Samjin, Hanmi Pharmaceutical Co., Ltd., Huino, Medtronic, Abbott, Boston, and Biotronik. GL has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi Sankyo, and as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi Sankyo. No fees were received either directly or personally from any of the institutions mentioned above. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of enrollment and analysis of the study population. AF, atrial fibrillation. *AF populations above 65 years of age with a medical history of an ischemic stroke or transient ischemic attack, or ones that met the following standards: female, with the presence of any of the related medical history (hypertensive disorders, diabetes, chronic renal disease, heart failure, or previous myocardial infarction).
FIGURE 2
FIGURE 2
Distribution of the hospital frailty risk score in study population recently diagnosed with atrial fibrillation. The patients were diagnosed within 1 year, receiving new rhythm-control or rate-control treatments among patients.
FIGURE 3
FIGURE 3
Initial choice of rhythm-control strategy. Treatments according to different frailty risk categories among patients who were recently (within 1 year) diagnosed with atrial fibrillation.
FIGURE 4
FIGURE 4
Weighted cumulative incidence curves for primary composite outcome. Curves shown for non-frail (A), moderately frail (B), and highly frail (C) patients who were recently (within 1 year) diagnosed with atrial fibrillation.
See this image and copyright information in PMC

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