Sun-Wook Kim1, Sol-Ji Yoon1, Jung-Yeon Choi1, Min-Gu Kang1, Youngjin Cho1, Il-Young Oh1, Cheol-Ho Kim1, Kwang-Il Kim2. 1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: kikim907@snu.ac.kr.
Abstract
BACKGROUND: We aimed to show the frailty status in older AF patients, and to find the association between frailty and the scores of CHA2DS2-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 (≥65years old) with AF, who underwent comprehensive geriatric assessment (CGA) between 2007 and 2014 in a single tertiary hospital. The CHA2DS2-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 CHA2DS2-VASc score (P<0.001) and the HAS-BLED score (P=0.01). Patients with high CHA2DS2-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. CHA2DS2-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 CHA2DS2-VASc and HAS-BLED scores.
BACKGROUND: We aimed to show the frailty status in older AFpatients, and to find the association between frailty and the scores of CHA2DS2-VASc and HAS-BLED. Ultimately, we sought to investigate the impact of frailty on cardiovascular and all-cause mortality in older AFpatients. METHODS: We retrospectively evaluated 365 patients (≥65years old) with AF, who underwent comprehensive geriatric assessment (CGA) between 2007 and 2014 in a single tertiary hospital. The CHA2DS2-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 CHA2DS2-VASc score (P<0.001) and the HAS-BLED score (P=0.01). Patients with high CHA2DS2-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. CHA2DS2-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 AFpatients, and provides additional prognostic value, along with the CHA2DS2-VASc and HAS-BLED scores.
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