Clinical implication of frailty assessment in older patients with atrial fibrillation

Background: We aimed to show the frailty status in older AF patients, and to find the association between frailty and the scores of CHA(2)DS(2)-VASc and HAS-BLED. Ultimately, we sought to investigate the impact of frailty on cardiovascular and all-cause mortality in older AF patients. Methods: We retrospectively evaluated 365 patients (>= 65 years old) with AF, who underwent comprehensive geriatric assessment (CGA) between 2007 and 2014 in a single tertiary hospital. The CHA(2)DS(2)-VASc and HAS-BLED scores were calculated based on the electronic medical records and the frailty index was computed from the CGA data. The primary outcomes were cardiovascular and all-cause mortality. Results: Frailty status was positively associated with the CHA(2)DS(2)-VASc score (P < 0.001) and the HASBLED score (P = 0.01). Patients with high CHA(2)DS(2)-VASc and HAS-BLED scores were more likely to be treated with anticoagulants rather than antiplatelet agents. However, frailty status was not associated with antithrombotic therapy. During the follow-up period (median [interquartile range], 22.9 [8.4-42.2] months), 141 patients (38.6%) died, of which 48 were due to cardiovascular events. CHA(2)DS(2)-VASc score could predict cardiovascular mortality, but not all-cause mortality. In contrast, frailty status was the independent predictor for both cardiovascular and all-cause mortality after adjusting for possible confounders (hazard ratio for all-cause mortality, 4.549; 95% CI, 2.756-7.509; P < 0.001). Conclusion: Frailty assessment can be used to predict mortality in older AF patients, and provides additional prognostic value, along with the CHA(2)DS(2)-VASc and HAS-BLED scores. (C) 2016 Elsevier Ireland Ltd. All rights reserved.