Clinical implication of frailty assessment in older patients with atrial fibrillation

Kim, Sunwook; Yoon, Sol-Ji; Choi, Jung Yeon; Kang, Min‐Gu; Cho, Youngjin; Oh, Il-Young; Kim, Cheol-Ho; Kim, Kwang Il

doi:10.1016/j.archger.2016.12.001

Cited by 28 publications

(18 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 16 However, the prevalence of frailty was comparable with that observed in studies on patients with atrial fibrillation (48.2%) or non-ST segment elevation myocardial infarction (48.5%). 20 , 21 In our study, the FI was significantly correlated with chronological age ( P <0.001 by the Spearman’s rank correlation coefficient) and negative health outcomes such as in-hospital mortality (4.6% vs 24.2%, P <0.001) and 30-day mortality (7.4% vs 28.4%, P <0.001). The variables used in the FI were deficits associated with health status and increasing prevalence with age.…”

Section: Discussionsupporting

confidence: 53%

Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia

Choi¹,

Kim²,

Yoon³

et al. 2018

CIA

Self Cite

View full text Add to dashboard Cite

PurposePneumonia poses a significant health risk in aging societies. We aimed to elucidate the determinative value of frailty for do-not-resuscitate (DNR) orders in pneumonia patients.Patients and methodsThis was a retrospective cohort study conducted at the Seoul National University Bundang Hospital (SNUBH) in Korea. Medical records of 431 pneumonia patients, aged 65 years and older, who were admitted between June 2014 and May 2015 were analyzed. Patients were categorized into DNR and no-DNR groups.ResultsAmong the 65 patients (15.1% of pneumonia patients) who completed DNR documents, 24 patients were survived, and 21 patients decided imminent to death (<24 hours before death), with all decisions determined by surrogates. The DNR group tended to be older and frail, with higher rates of renal impairment and malnutrition, and had a lower microbiology detection effort than the no-DNR group. The DNR group used a high number of broad-spectrum antibiotics, experienced high levels of in-hospital (63.1% vs 5.7%, P<0.001) and 30-day (64.6% vs 9.6%, P<0.001) mortality rates, and had prolonged hospital stays (median length of hospital stay, 12 vs 9 days, P=0.020). Frailty was independently associated with DNR status even after adjustment for sepsis, septic shock, and the pneumonia severity index (PSI) score. Frailty also significantly influenced healthcare setting transitions after adjustment for sepsis, septic shock, and the PSI.ConclusionWe identified the factors associated with DNR orders and their prognoses among elderly Koreans with pneumonia. Frailty was significantly associated with DNR decision and healthcare setting transitions in pneumonia patients.

show abstract

Section: Discussionsupporting

confidence: 53%

Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia

Choi¹,

Kim²,

Yoon³

et al. 2018

CIA

Self Cite

View full text Add to dashboard Cite

show abstract

“… 32) While frailty correlates with higher CHA 2 DS 2 -VASc and HAS-BLED scores in AF patients, it may be independently predictive of both cardiovascular and all-cause mortality. 33) It is, therefore, unsurprising that frailty is a common reason for discontinuing or not starting OAC. 34) 35) There is very little information about the risk and benefits of long-term OAC treatment in this population.…”

Section: Frailtymentioning

confidence: 99%

Anticoagulation for Stroke Prevention in Older Adults with Atrial Fibrillation and Comorbidity: Current Evidence and Treatment Challenges

et al. 2018

View full text Add to dashboard Cite

The burden of atrial fibrillation (AF) is projected to increase substantially over the next decade in parallel with the aging of the population. The increasing age, level of comorbidity, and polypharmacy will complicate the treatment of older adults with AF. For instance, advanced age and chronic kidney disease have been shown to increase the risk of both thromboembolism and bleeding in patients with AF. Frailty, recurrent falls and polypharmacy, while very common among elderly patients with AF, are often overlooked in the clinical decision making despite their significant interaction with oral anticoagulant (OAC) and profound impact on the patient's clinical outcomes. Such factors should be recognized, evaluated and considered in a comprehensive decision-making process. The introduction of non-vitamin K oral anticoagulants has radically changed the management of AF allowing for a more individualized selection of OAC. An understanding of the available data regarding the performance of each of the available OAC in a variety of at risk patient populations is paramount for the safe and effective management of this patient population. The aim of this review is to appraise the current evidence, point out the gaps in knowledge, and provide recommendations regarding stroke prevention in older adults with AF and comorbid conditions.

show abstract

“…In general, frailty leads to a higher risk of disability, hospital admission and death,21 and this higher risk has been reported in patients with AF 11. In this study, it is interesting that frailty remained a risk factor for the composite end points despite accounting for established risk factors such as age, CHA 2 DS 2 -VASc score and HAS-BLED score in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 63%

“…There have also been reports that AF is associated with frailty 10. Frailty is a prognostic factor in patients with AF,11 but to our knowledge, there are no reports on the prognostic potential of frailty in patients with AF who are taking DOAC. Therefore, we examined the associations between frailty and clinical adverse events in patients with AF taking DOAC in daily clinical practice.…”

Section: Introductionmentioning

confidence: 96%

The influence of frailty under direct oral anticoagulant use in patients with atrial fibrillation

et al. 2019

View full text Add to dashboard Cite

BackgroundFrailty is a prognostic factor in patients with atrial fibrillation (AF). However, there is no report on the associations between frailty and clinical adverse events in patients with AF taking direct oral anticoagulants (DOAC). The factors related to the occurrence of clinical adverse events are still under discussion. Therefore, we examined the associations between frailty and clinical adverse events in patients with AF taking DOAC in daily clinical practice.MethodsWe retrospectively evaluated 240 consecutive patients with AF who had been newly prescribed DOAC in our hospital from April 2016 through May 2017. Data collected included Clinical Frailty Scale (CFS) scores, laboratory results and basic demographic information.ResultsDuring the mean follow-up period of 13.4 months, 20 patients died (7.6 per 100 person-years), stroke or systemic embolism occurred in seven patients (2.6 per 100 person-years) and major bleeding occurred in 11 patients (4.2 per 100 person-years). We defined these adverse events as composite end points, and we estimated adjusted HRs and 95% CIs for risk factors using the Cox proportional hazard regression model. Frailty (defined as a CFS score of 5 or more; HR: 3.71; 95% CI: 1.59 to 8.65), female sex (HR: 3.49; 95% CI: 1.73 to 7.07), serum albumin level (HR: 0.47; 95% CI: 0.28 to 0.79) and malignancy (HR: 4.02; 95% CI: 1.83 to 8.84) were independent predictors of the composite end points.ConclusionsFrailty, female sex, hypoalbuminaemia and malignancy were associated with clinical adverse events in patients with AF who were prescribed DOAC.

show abstract

Clinical implication of frailty assessment in older patients with atrial fibrillation

Cited by 28 publications

References 33 publications

Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia

Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia

Anticoagulation for Stroke Prevention in Older Adults with Atrial Fibrillation and Comorbidity: Current Evidence and Treatment Challenges

The influence of frailty under direct oral anticoagulant use in patients with atrial fibrillation

Contact Info

Product

Resources

About