Epidemiology and impact of frailty in patients with atrial fibrillation in Europe
Authors: Proietti Marco , Romiti Giulio Francesco , Vitolo Marco , Harrison Stephanie L , Lane Deirdre A , Fauchier Laurent , Marin Francisco , Näbauer Michael , Potpara Tatjana S , Dan Gheorghe-Andrei , Maggioni Aldo P , Cesari Matteo , Boriani Giuseppe , Lip Gregory Y H ,   ESC-EHRA EORP-AF General Long-Term Registry Investigators, Zëra E , Ekmekçiu U , Paparisto V , Tase M , Gjergo H , Dragoti J , Goda A , Ciutea M , Ahadi N , el Husseini Z , Raepers M , Leroy J , Haushan P , Jourdan A , Lepiece C , Desteghe L , Vijgen J , Koopman P , Van Genechten G , Heidbuchel H , Boussy T , De Coninck M , Van Eeckhoutte H , Bouckaert N , Friart A , Boreux J , Arend C , Evrard P , Stefan L , Hoffer E , Herzet J , Massoz M , Celentano C , Sprynger M , Pierard L , Melon P , Van Hauwaert B , Kuppens C , Faes D , Van Lier D , Van Dorpe A , Gerardy A , Deceuninck O , Xhaet O , Dormal F , Ballant E , Blommaert D , Yakova D , Hristov M , Yncheva T , Stancheva N , Tisheva S , Tokmakova M , Nikolov F , Gencheva D , Shalganov T , Kunev B , Stoyanov M , Marchov D , Gelev V , Traykov V , Kisheva A , Tsvyatkov H , Shtereva R , Bakalska-Georgieva S , Slavcheva S , Yotov Y , Kubíčková M , Marni Joensen A , Gammelmark A , Hvilsted Rasmussen L , Dinesen P , Riahi S , Krogh Venø S , Sorensen B , Korsgaard A , Andersen K , Fragtrup Hellum C , Svenningsen A , Nyvad O , Wiggers P , May O , Aarup A , Graversen B , Jensen L , Andersen M , Svejgaard M , Vester S , Hansen S , Lynggaard V , Ciudad M , Vettus R , Muda P , Maestre A , Castaño S , Cheggour S , Poulard J , Mouquet V , Leparrée S , Bouet J , Taieb J , Doucy A , Duquenne H , Furber A , Dupuis J , Rautureau J , Font M , Damiano P , Lacrimini M , Abalea J , Boismal S , Menez T , Mansourati J , Range G , Gorka H , Laure C , Vassalière C , Elbaz N , Lellouche N , Djouadi K , Roubille F , Dietz D , Davy J , Granier M , Winum P , Leperchois-Jacquey C , Kassim H , Marijon E , Le Heuzey J , Fedida J , Maupain C , Himbert C , Gandjbakhch E , Hidden-Lucet F , Duthoit G , Badenco N , Chastre T , Waintraub X , Oudihat M , Lacoste J , Stephan C , Bader H , Delarche N , Giry L , Arnaud D , Lopez C , Boury F , Brunello I , Lefèvre M , Mingam R , Haissaguerre M , Le Bidan M , Pavin D , Le Moal V , Leclercq C , Piot O , Beitar T , Martel I , Schmid A , Sadki N , Romeyer-Bouchard C , Da Costa A , Arnault I , Boyer M , Piat C , Fauchier L , Lozance N , Nastevska S , Doneva A , Fortomaroska Milevska B , Sheshoski B , Petroska K , Taneska N , Bakrecheski N , Lazarovska K , Jovevska S , Ristovski V , Antovski A , Lazarova E , Kotlar I , Taleski J , Poposka L , Kedev S , Zlatanovik N , Jordanova S , Bajraktarova Proseva T , Doncovska S , Maisuradze D , Esakia A , Sagirashvili E , Lartsuliani K , Natelashvili N , Gumberidze N , Gvenetadze R , Etsadashvili K , Gotonelia N , Kuridze N , Papiashvili G , Menabde I , Glöggler S , Napp A , Lebherz C , Romero H , Schmitz K , Berger M , Zink M , Köster S , Sachse J , Vonderhagen E , Soiron G , Mischke K , Reith R , Schneider M , Rieker W , Boscher D , Taschareck A , Beer A , Oster D , Ritter O , Adamczewski J , Walter S , Frommhold A , Luckner E , Richter J , Schellner M , Landgraf S , Bartholome S , Naumann R , Schoeler J , Westermeier D , William F , Wilhelm K , Maerkl M , Oekinghaus R , Denart M , Kriete M , Tebbe U , Scheibner T , Gruber M , Gerlach A , Beckendorf C , Anneken L , Arnold M , Lengerer S , Bal Z , Uecker C , Förtsch H , Fechner S , Mages V , Martens E , Methe H , Schmidt T , Schaeffer B , Hoffmann B , Moser J , Heitmann K , Willems S , Willems S , Klaus C , Lange I , Durak M , Esen E , Mibach F , Mibach H , Utech A , Gabelmann M , Stumm R , Ländle V , Gartner C , Goerg C , Kaul N , Messer S , Burkhardt D , Sander C , Orthen R , Kaes S , Baumer A , Dodos F , Barth A , Schaeffer G , Gaertner J , Winkler J , Fahrig A , Aring J , Wenzel I , Steiner S , Kliesch A , Kratz E , Winter K , Schneider P , Haag A , Mutscher I , Bosch R , Taggeselle J , Meixner S , Schnabel A , Shamalla A , Hötz H , Korinth A , Rheinert C , Mehltretter G , Schön B , Schön N , Starflinger A , Englmann E , Baytok G , Laschinger T , Ritscher G , Gerth A , Dechering D , Eckardt L , Kuhlmann M , Proskynitopoulos N , Brunn J , Foth K , Axthelm C , Hohensee H , Eberhard K , Turbanisch S , Hassler N , Koestler A , Stenzel G , Kschiwan D , Schwefer M , Neiner S , Hettwer S , Haeussler-Schuchardt M , Degenhardt R , Sennhenn S , Steiner S , Brendel M , Stoehr A , Widjaja W , Loehndorf S , Logemann A , Hoskamp J , Grundt J , Block M , Ulrych R , Reithmeier A , Panagopoulos V , Martignani C , Bernucci D , Fantecchi E , Diemberger I , Ziacchi M , Biffi M , Cimaglia P , Frisoni J , Boriani G , Giannini I , Boni S , Fumagalli S , Pupo S , Di Chiara A , Mirone P , Fantecchi E , Boriani G , Pesce F , Zoccali C , Malavasi V L , Mussagaliyeva A , Ahyt B , Salihova Z , Koshum-Bayeva K , Kerimkulova A , Bairamukova A , Mirrakhimov E , Lurina B , Zuzans R , Jegere S , Mintale I , Kupics K , Jubele K , Erglis A , Kalejs O , Vanhear K , Burg M , Cachia M , Abela E , Warwicker S , Tabone T , Xuereb R , Asanovic D , Drakalovic D , Vukmirovic M , Pavlovic N , Music L , Bulatovic N , Boskovic A , Uiterwaal H , Bijsterveld N , De Groot J , Neefs J , van den Berg N , Piersma F , Wilde A , Hagens V , Van Es J , Van Opstal J , Van Rennes B , Verheij H , Breukers W , Tjeerdsma G , Nijmeijer R , Wegink D , Binnema R , Said S , Erküner Ö , Philippens S , van Doorn W , Crijns H , Szili-Torok T , Bhagwandien R , Janse P , Muskens A , van Eck M , Gevers R , van der Ven N , Duygun A , Rahel B , Meeder J , Vold A , Holst Hansen C , Engset I , Atar D , Dyduch-Fejklowicz B , Koba E , Cichocka M , Sokal A , Kubicius A , Pruchniewicz E , Kowalik-Sztylc A , Czapla W , Mróz I , Kozlowski M , Pawlowski T , Tendera M , Winiarska-Filipek A , Fidyk A , Slowikowski A , Haberka M , Lachor-Broda M , Biedron M , Gasior Z , Kołodziej M , Janion M , Gorczyca-Michta I , Wozakowska-Kaplon B , Stasiak M , Jakubowski P , Ciurus T , Drozdz J , Simiera M , Zajac P , Wcislo T , Zycinski P , Kasprzak J , Olejnik A , Harc-Dyl E , Miarka J , Pasieka M , Ziemińska-Łuć M , Bujak W , Śliwiński A , Grech A , Morka J , Petrykowska K , Prasał M , Hordyński G , Feusette P , Lipski P , Wester A , Streb W , Romanek J , Woźniak P , Chlebuś M , Szafarz P , Stanik W , Zakrzewski M , Kaźmierczak J , Przybylska A , Skorek E , Błaszczyk H , Stępień M , Szabowski S , Krysiak W , Szymańska M , Karasiński J , Blicharz J , Skura M , Hałas K , Michalczyk L , Orski Z , Krzyżanowski K , Skrobowski A , Zieliński L , Tomaszewska-Kiecana M , Dłużniewski M , Kiliszek M , Peller M , Budnik M , Balsam P , Opolski G , Tymińska A , Ozierański K , Wancerz A , Borowiec A , Majos E , Dabrowski R , Szwed H , Musialik-Lydka A , Leopold-Jadczyk A , Jedrzejczyk-Patej E , Koziel M , Lenarczyk R , Mazurek M , Kalarus Z , Krzemien-Wolska K , Starosta P , Nowalany-Kozielska E , Orzechowska A , Szpot M , Staszel M , Almeida S , Pereira H , Brandão Alves L , Miranda R , Ribeiro L , Costa F , Morgado F , Carmo P , Galvao Santos P , Bernardo R , Adragão P , Ferreira da Silva G , Peres M , Alves M , Leal M , Cordeiro A , Magalhães P , Fontes P , Leão S , Delgado A , Costa A , Marmelo B , Rodrigues B , Moreira D , Santos J , Santos L , Terchet A , Darabantiu D , Mercea S , Turcin Halka V , Pop Moldovan A , Gabor A , Doka B , Catanescu G , Rus H , Oboroceanu L , Bobescu E , Popescu R , Dan A , Buzea A , Daha I , Dan G , Neuhoff I , Baluta M , Ploesteanu R , Dumitrache N , Vintila M , Daraban A , Japie C , Badila E , Tewelde H , Hostiuc M , Frunza S , Tintea E , Bartos D , Ciobanu A , Popescu I , Toma N , Gherghinescu C , Cretu D , Patrascu N , Stoicescu C , Udroiu C , Bicescu G , Vintila V , Vinereanu D , Cinteza M , Rimbas R , Grecu M , Cozma A , Boros F , Ille M , Tica O , Tor R , Corina A , Jeewooth A , Maria B , Georgiana C , Natalia C , Alin D , Dinu-Andrei D , Livia M , Daniela R , Larisa R , Umaar S , Tamara T , Ioachim Popescu M , Nistor D , Sus I , Coborosanu O , Alina-Ramona N , Dan R , Petrescu L , Ionescu G , Popescu I , Vacarescu C , Goanta E , Mangea M , Ionac A , Mornos C , Cozma D , Pescariu S , Solodovnicova E , Soldatova I , Shutova J , Tjuleneva L , Zubova T , Uskov V , Obukhov D , Rusanova G , Soldatova I , Isakova N , Odinsova S , Arhipova T , Kazakevich E , Serdechnaya E , Zavyalova O , Novikova T , Riabaia I , Zhigalov S , Drozdova E , Luchkina I , Monogarova Y , Hegya D , Rodionova L , Rodionova L , Nevzorova V , Soldatova I , Lusanova O , Arandjelovic A , Toncev D , Milanov M , Sekularac N , Zdravkovic M , Hinic S , Dimkovic S , Acimovic T , Saric J , Polovina M , Potpara T , Vujisic-Tesic B , Nedeljkovic M , Zlatar M , Asanin M , Vasic V , Popovic Z , Djikic D , Sipic M , Peric V , Dejanovic B , Milosevic N , Stevanovic A , Andric A , Pencic B , Pavlovic-Kleut M , Celic V , Pavlovic M , Petrovic M , Vuleta M , Petrovic N , Simovic S , Savovic Z , Milanov S , Davidovic G , Iric-Cupic V , Simonovic D , Stojanovic M , Stojanovic S , Mitic V , Ilic V , Petrovic D , Deljanin Ilic M , Ilic S , Stoickov V , Markovic S , Kovacevic S , García Fernandez A , Perez Cabeza A , Anguita M , Tercedor Sanchez L , Mau E , Loayssa J , Ayarra M , Carpintero M , Roldán Rabadan I , Leal M , Gil Ortega M , Tello Montoliu A , Orenes Piñero E , Manzano Fernández S , Marín F , Romero Aniorte A , Veliz Martínez A , Quintana Giner M , Ballesteros G , Palacio M , Alcalde O , García-Bolao I , Bertomeu Gonzalez V , Otero-Raviña F , García Seara J , Gonzalez Juanatey J , Dayal N , Maziarski P , Gentil-Baron P , Shah D , Koç M , Onrat E , Dural I E , Yilmaz K , Özin B , Tan Kurklu S , Atmaca Y , Canpolat U , Tokgozoglu L , Dolu A K , Demirtas B , Sahin D , Ozcan Celebi O , Diker E , Gagirci G , Turk U O , Ari H , Polat N , Toprak N , Sucu M , Akin Serdar O , Taha Alper A , Kepez A , Yuksel Y , Uzunselvi A , Yuksel S , Sahin M , Kayapinar O , Ozcan T , Kaya H , Yilmaz M B , Kutlu M , Demir M , Gibbs C , Kaminskiene S , Bryce M , Skinner A , Belcher G , Hunt J , Stancombe L , Holbrook B , Peters C , Tettersell S , Shantsila A , Lane D , Senoo K , Proietti M , Russell K , Domingos P , Hussain S , Partridge J , Haynes R , Bahadur S , Brown R , McMahon S , Y H Lip G , McDonald J , Balachandran K , Singh R , Garg S , Desai H , Davies K , Goddard W , Galasko G , Rahman I , Chua Y , Payne O , Preston S , Brennan O , Pedley L , Whiteside C , Dickinson C , Brown J , Jones K , Benham L , Brady R , Buchanan L , Ashton A , Crowther H , Fairlamb H , Thornthwaite S , Relph C , McSkeane A , Poultney U , Kelsall N , Rice P , Wilson T , Wrigley M , Kaba R , Patel T , Young E , Law J , Runnett C , Thomas H , McKie H , Fuller J , Pick S , Sharp A , Hunt A , Thorpe K , Hardman C , Cusack E , Adams L , Hough M , Keenan S , Bowring A , Watts J , Zaman J , Goffin K , Nutt H , Beerachee Y , Featherstone J , Mills C , Pearson J , Stephenson L , Grant S , Wilson A , Hawksworth C , Alam I , Robinson M , Ryan S , Egdell R , Gibson E , Holland M , Leonard D , Mishra B , Ahmad S , Randall H , Hill J , Reid L , George M , McKinley S , Brockway L , Milligan W , Sobolewska J , Muir J , Tuckis L , Winstanley L , Jacob P , Kaye S , Morby L , Jan A , Sewell T , Boos C , Wadams B , Cope C , Jefferey P , Andrews N , Getty A , Suttling A , Turner C , Hudson K , Austin R , Howe S , Iqbal R , Gandhi N , Brophy K , Mirza P , Willard E , Collins S , Ndlovu N , Subkovas E , Karthikeyan V , Waggett L , Wood A , Bolger A , Stockport J , Evans L , Harman E , Starling J , Williams L , Saul V , Sinha M , Bell L , Tudgay S , Kemp S , Brown J , Frost L , Ingram T , Loughlin A , Adams C , Adams M , Hurford F , Owen C , Miller C , Donaldson D , Tivenan H , Button H , Nasser A , Jhagra O , Stidolph B , Brown C , Livingstone C , Duffy M , Madgwick P , Roberts P , Greenwood E , Fletcher L , Beveridge M , Earles S , McKenzie D , Beacock D , Dayer M , Seddon M , Greenwell D , Luxton F , Venn F , Mills H , Rewbury J , James K , Roberts K , Tonks L , Felmeden D , Taggu W , Summerhayes A , Hughes D , Sutton J , Felmeden L , Khan M , Walker E , Norris L , O’Donohoe L , Mozid A , Dymond H , Lloyd-Jones H , Saunders G , Simmons D , Coles D , Cotterill D , Beech S , Kidd S , Wrigley B , Petkar S , Smallwood A , Jones R , Radford E , Milgate S , Metherell S , Cottam V , Buckley C , Broadley A , Wood D , Allison J , Rennie K , Balian L , Howard L , Pippard L , Board S , Pitt-Kerby T 
Published: December 2022

Abstract

Background
Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

Objectives
We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

Methods
A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

Results
Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55–0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

Conclusions
In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.