Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jun 1;6(2):195-206.
doi: 10.1002/agm2.12214. eCollection 2023 Jun.

Frailty and oral anticoagulant prescription in adults with atrial fibrillation: A systematic review

Mary Bul  1 , Fahad Shaikh  1   2 , Julee McDonagh  3 , Caleb Ferguson  1   2   4
Affiliations
Review

Frailty and oral anticoagulant prescription in adults with atrial fibrillation: A systematic review

Mary Bul et al. Aging Med (Milton). .

Abstract

Objectives: The objectives of this study were to determine the prevalence of frailty in the context of atrial fibrillation (AF); to identify the most commonly used frailty instruments in AF; and to describe the effect of frailty on non-vitamin K oral anticoagulant (NOAC) prescription for stroke prevention in adults with AF.

Methods: A systematic search of databases, including Medline, Embase, Web of Science, Cochrane Library, Scopus, and CINAHL, was conducted using search terms including "atrial fibrillation," "frailty," and "anticoagulation." A narrative synthesis was undertaken.

Results: A total of 92 articles were screened, and 12 articles were included. The mean age of the participants (n = 212,111) was 82 years (range = 77-85 years) with 56% of participants identified as frail and 44% identified non-frail. A total of five different frailty instruments were identified: the Frailty Phenotype (FP; n = 5, 42%), the Clinical Frailty Scale (CFS; n = 4, 33%), Cumulative Deficit Model of Frailty (CDM; n = 1, 8%), Edmonton Frail Scale (n = 1, 8%) and the Resident Assessment Instrument - Minimum Data Set (RAI-MDS 2.0; n = 1, 8%). Frailty was identified as an important barrier to anticoagulant therapy with 52% of the frail population anticoagulated vs 67% non-frail.

Conclusion: Frailty is an important consideration in anticoagulation decision making for stroke prevention in patients with AF. There is scope to improve frailty screening and treatment. Frailty status is an important risk marker and should be considered when evaluating stroke risk alongside congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke, transient ischemic attack, or thromboembolism, vascular disease, age 65-74 years, sex category (CHA2DS2-VASc) and Hypertension, Abnormal renal/liver function, Stroke, Bleeding, Labile, Elderly, and Drugs (HAS-BLED) scores.

Keywords: anticoagulation, atrial fibrillation, frailty.

PubMed Disclaimer

Conflict of interest statement

Nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flow diagram
FIGURE 2
FIGURE 2
Rates of frailty vs proportion prescribed anticoagulant amongst participants with atrial fibrillation (AF)
FIGURE 3
FIGURE 3
Anticoagulant distribution. VKA, vitamin K antagonist. *Excludes the following studies: Gullón et al. (2018), D. Lefebvre et al. (2016), Ohta et al. (2021), Wang et al. (2019), and Yamamoto et al. (2019)
See this image and copyright information in PMC

References

    1. Lefebvre MCD, St‐Onge M, Glazer‐Cavanagh M, et al. The effect of bleeding risk and frailty status on anticoagulation patterns in octogenarians with atrial fibrillation: the FRAIL‐AF study. Can J Cardiol. 2016;32(2):169‐176. doi:10.1016/j.cjca.2015.05.012 - DOI - PubMed
    1. Annoni G, Mazzola P. Real‐world characteristics of hospitalized frail elderly patients with atrial fibrillation: can we improve the current prescription of anticoagulants? J Geriatr Cardiol. 2016;13(3):226‐232. doi:10.11909/j.issn.1671-5411.2016.03.010 - DOI - PMC - PubMed
    1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370‐2375. - PubMed
    1. Sudlow M, Thomson R, Thwaites B, Rodgers H, Kenny RA. Prevalence of atrial fibrillation and eligibility for anticoagulants in the community. Lancet. 1998;352(9135):1167‐1171. - PubMed
    1. Karamichalakis N, Letsas KP, Vlachos K, et al. Managing atrial fibrillation in the very elderly patient: challenges and solutions. Vasc Health Risk Manag. 2015;11:555‐562. doi:10.2147/VHRM.S83664 - DOI - PMC - PubMed