Management of atrial fibrillation for older people with frailty: a systematic review and meta-analysis.
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TLDR
There is evidence of an association between frailty status and OAC prescription, with different direction of effect in community compared with hospital cohorts, and frailty is common, and associated with adverse clinical outcomes in patients with AF.Abstract:
Background despite a large and growing population of older people with frailty and atrial fibrillation (AF), there is a lack of guidance on optimal AF management in this high-risk group. Objective to synthesise the existing evidence base on the association between frailty, AF and clinical outcomes. Methods a systematic review of studies examining the association between validated measures of frailty, AF and clinical outcomes, and meta-analysis of the association between frailty and oral anticoagulation (OAC) prescription. Results twenty studies (30,883 patients) were included, all observational. Fifteen were in hospital, four in the community, one in nursing care. Risk of bias was low-to-moderate. AF prevalence was 3%-38%. In people with AF, frailty was associated with increased stroke incidence, all-cause mortality, symptom severity and length of hospital stay.Meta-analysis of six studies showed frailty was associated with decreased OAC prescription at hospital admission (pooled adjusted OR 0.45 [95%CI 0.22-0.93], three studies), but not at discharge (pooled adjusted OR 0.40 [95%CI 0.13-1.23], three studies). A community-based study showed increased OAC prescription associated with frailty (OR 2.33 [95%CI 1.03-5.23]). Conclusion frailty is common, and associated with adverse clinical outcomes in patients with AF. There is evidence of an association between frailty status and OAC prescription, with different direction of effect in community compared with hospital cohorts. Despite the majority of care for older people being provided in the community, there is a lack of evidence on the association between frailty, AF, anticoagulation and clinical outcomes to guide optimal care in this setting.read more
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The degree of frailty as a translational measure of health in aging
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Atrial Fibrillation in Older People: Concepts and Controversies
TL;DR: Light is shed on common misconceptions that appear to serve as rationale for precluding OAC and clinical considerations that may aid OAC prescription decisions where appropriate are focused on to optimize AF management using an integrated, multi-disciplinary care approach.
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Optimizing indices of AF susceptibility and burden to evaluate AF severity, risk and outcomes.
Giuseppe Boriani,Marco Vitolo,Igor Diemberger,Marco Proietti,Anna Chiara Valenti,Vincenzo Livio Malavasi,Gregory Y.H. Lip,Gregory Y.H. Lip +7 more
TL;DR: In this paper, atrial fibrillation (AF) has heterogeneous patterns of presentation concerning symptoms, duration of episodes, AF burden, and the tendency to progress towards the terminal step of permanent AF.
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Clinical outcomes in patients with atrial fibrillation and frailty: insights from the ENGAGE AF-TIMI 48 trial.
Chris Wilkinson,Jianhua Wu,Samuel D Searle,Samuel D Searle,Oliver Todd,Oliver Todd,Marlous Hall,Vijay Kunadian,Vijay Kunadian,Andrew Clegg,Andrew Clegg,Kenneth Rockwood,Kenneth Rockwood,Chris P Gale,Chris P Gale +14 more
TL;DR: Overall, with increasing frailty, there was an increase in stroke and bleeding risk and there is a need for high-quality, frailty-specific population randomised control trials to guide therapy in this vulnerable population.
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Atrial fibrillation and oral anticoagulation in older people with frailty: a nationwide primary care electronic health records cohort study.
Chris Wilkinson,Andrew Clegg,Oliver Todd,Oliver Todd,Kenneth Rockwood,Mohammad E Yadegarfar,Chris P Gale,Chris P Gale,Marlous Hall +8 more
TL;DR: Among older people in England, AF and stroke risk increased with increasing degree of frailty; however, OAC prescription approximated 50%.
References
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Frailty in elderly people
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