Implication of different frailty criteria in older people with atrial fibrillation: a prospective cohort study

Abstract

Backgroundthe prevalence of physical and multidimensional frailty and their prognostic impact on clinical outcomes in patients with atrial fibrillation (AF) is unclear.Objectiveto evaluated frailty in a cohort of patients with AF according to different criteria, and studied the prevalence and its prognostic impact on clinical outcomes.Methodsin this multicenter prospective cohort, 197 inpatients >= 65 years old with AF were recruited from September 2018 to April 2019.We used Fried Frailty phenotype (Fried) to assess physical frailty, and comprehensive geriatric assessment-frailty index (CGA-FI) to assess multidimensional frailty. The primary outcome was a composite of all-cause mortality or rehospitalization.Resultsthe prevalence of frailty was determined as 34.5% by Fried, 42.6% by CGA-FI. Malnutrition and >= 7 medications were independently associated with frailty. Kaplan-Meier survival curve showed that the presence of frailty by CGA-FI had significantly lower all-cause mortality or rehospitalization survival rate (log-rank P = 0.04) within 1 year. Multivariate Cox regression adjusted for age and sex showed that the frailty by CGA-FI was significantly associated with the risk of all-cause mortality or rehospitalization within 1 year (HR 1.79, 95% CI 1.10-2.90). However, those associations were absent with the physical frailty. After broader multivariate adjustment, those associations were no longer statistically significant for both types of frailty.Conclusionsin older people with AF, Multidimensional frailty is more significantly associated with a composite of all-cause mortality or rehospitalization within 1 year than physical frailty, but these association are attenuated after multivariate adjustment.Clinical trial registrationChiCTR1800017204; date of registration: 07/18/2018. The prevalence of multidimensional frailty (42.6% by CGA-FI) was higher than that of physical frailty (34.5% by Fried) in older people with AF.Malnutrition and polypharmacy were independent risk factors for frailty.In older people with AF, multidimensional frailty was more significantly associated with a composite of all-cause mortality or rehospitalization within 1 year than physical frailty, but these association were attenuated after multivariate adjustment.