Influence of frailty on anticoagulant prescription and clinical outcomes after 1-year follow-up in hospitalised older patients with atrial fibrillation
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Frailty is an important prognostic factor in older adults with cardiovascular diseases. We aim to describe the characteristics of elderly hospitalised frail patients with non-valvular atrial fibrillation (NVAF) and to assess the influence of frailty, along with other functional and health status variables on anticoagulation prescription, 1-year all-cause mortality, and the incidence of ischemic and bleeding complications. An observational, prospective multicentre study was carried out on patients with NVAF over the age of 75, who were admitted to the Internal Medicine departments in Spain. A total of 615 patients were evaluated (mean age 85.23 ± 5.16 years, 54.3% females, 48.3% frail). Frail patients had higher CHA2DS2-VASc and HAS-BLED scores, more comorbidities and worse functional status and cognitive impairment compared to non-frail. During hospitalisation, 58 (9.4%) patients died (12.5% frail, 6.6% non-frail, p = 0.01). Among the participants discharged, 69.8% received anticoagulants, 13% anti-platelets only and 16.9% no anti-thrombotics, with no difference by frailty status. Frailty is not a predictor of anticoagulant prescription at discharge (OR 0.93, 95% CI 0.55–1.57), while functional dependency remains significantly associated (OR for severe dependency 0.44, 95% CI 0.23–0.82). After the 1-year follow-up, frail patients have a higher risk of death (HR 1.99, 95% CI 1.43–2.76). Among patients taking anticoagulants, the incidence of stroke and major bleeding is similar between frailty groups. In our study, frailty is related to worse global health status. It has no impact on antithrombotic prescription, nor is a predictor of AF complications, even though frail subjects have a higher mortality during hospitalisation and after 1-year follow-up.
KeywordsAtrial fibrillation Anticoagulants Aged Frailty Elderly Antithrombotic therapy
We wish to acknowledge all the investigators of the NONAVASC registry for collecting data for the study, and also would like to thank Mr M. Gómez for his kind review of the final draft of the manuscript.
M. Camafort Babkowski, E. Rovira Daudí, E. Jarauta Simón, I. García Polo, J.C. Arévalo Lorido, J. Portillo Sánchez, I. Martínez Moreno, C. de la Guerra Acebal, C. Argüello Martín, SI. Aranda Sánchez, I. Novo Veleiro, M. Pena Seijo, F. Salgado Ordoñez, J.A. Vargas Hitos, J. González Moraleja, NR. Tobares Carrasco, P. Freixas Descarrega, I. Campodarve Botet, C. Fernández Capitán, LM. Palomar Rodríguez, AB. Gómez Belda, D. Chivite Guillén, M.A. Rico Corral, JL. Hernández Hernández, E. Coloma Bazán, X. Sobrino Martínez, J. Grandes Ibáñez, M. Martín Millán, R. Cuenca Acevedo, JB. Pérez Lorenz, A. de la Peña Fernández, G. López Castellanos, E. Montero Hernández, E. Calderón Sandubete, C. Lahoz Rallo, A. de los Santos Moreno, J.A. Martínez Muradas, J. Alfonso Megido, J.I. Cuende Melero, R. Cotos Cancas, JJ. Tamarit García, F. Bonilla Rovira, A. Epalza Bueno, M. Morales Conejo, L. Manzano Espinosa, S. Freire Castro, A. Rodríguez González, M. Menduiña Guillén, A. López Suárez, JF. Sánchez Muñoz- Torrero, M.D. Martín Escalante, JA. Ortiz Minuesa, J.C. Martínez-Acitores, M.B. Alonso Ortiz, D. Filella Agulló, H. Ágreda López, M. Romero Jiménez, ME. Fernández Pérez, J.L. Díaz Díaz, C. Pérez Bocanegra, R. Martínez Fernández, J.A. Nieto Rodríguez, J. Masferrer Serra, L. Mérida Rodrigo, J.M. Varela Aguilar, A. Mujal Martínez, L. Castilla Guerra, P. Castellanos Llauger, G. Tiberio López, E. Guevara Sierra, and J. Fernández Pardo.
The registry website was funded by a non-conditioned grant from Bayer Laboratories.
Compliance with ethical standards
Conflict of interest
None of the authors have had any relationship with industry and financial associations that might pose a conflict of interest with the manuscript.
Statements on human and animal rights
The study is approved by the appropriate institutional research ethics committee. All procedures performed in the study involving human participants are in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
A written informed consent was obtained from all participants included in the study.
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