Yu, Ga-In, Kim, Daehoon, Sung, Jung-Hoon, Jang, Eunsun, Yu, Hee Tae, Kim, Tae-Hoon, Pak, Hui-Nam, Lee, Moon-Hyoung, Lip, Gregory YH 
ORCID: 0000-0002-7566-1626, Yang, Pil-Sung et al (show 1 more authors)
(2023)
Impact of frailty on early rhythm control outcomes in older adults with atrial fibrillation: A nationwide cohort study.
FRONTIERS IN CARDIOVASCULAR MEDICINE, 9.
1050744-.
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Impact of frailty on early rhythm control outcomes in older adults with atrial fibrillation A nationwide cohort study.pdf - Open Access published version Download (4MB) | Preview |
Abstract
<h4>Purpose</h4>Rhythm-control therapy administered early following the initial diagnosis of atrial fibrillation (AF) has superior cardiovascular outcomes compared to rate-control therapy. Frailty is a key factor in identifying older patients' potential for improvement after rhythm-control therapy. This study evaluated whether frailty affects the outcome of early rhythm-control therapy in older patients with AF.<h4>Methods</h4>From the Korean National Health Insurance Service database (2005-2015), we collected 20,611 populations aged ≥65 years undergoing rhythm- or rate-control therapy initiated within 1 year of AF diagnosis. Participants were emulated by the EAST-AFNET4 trial, and stratified into non-frail, moderately frail, and highly frail groups based on the hospital frailty risk score (HFRS). A composite outcome of cardiovascular-related mortality, myocardial infarction, hospitalization for heart failure, and ischemic stroke was compared between rhythm- and rate-control.<h4>Results</h4>Early rhythm-control strategy showed a 14% lower risk of the primary composite outcome in the non-frail group [weighted incidence 7.3 vs. 8.6 per 100 person-years; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.79-0.93, <i>p</i> < 0.001] than rate-control strategy. A consistent trend toward a lower risk of early rhythm-control was observed in the moderately frail (HR 0.91, 95% CI 0.81-1.02, <i>p</i> = 0.09) and highly frail (HR 0.93, 95% CI 0.75-1.17, <i>p</i> = 0.55) groups.<h4>Conclusion</h4>Although the degree attenuated with increasing frailty, the superiority of cardiovascular outcomes of early rhythm-control in AF treatment was maintained without increased risk for safety outcomes. An individualized approach is required on the benefits of early rhythm-control therapy in older patients with AF, regardless of their frailty status.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | atrial fibrillation, rhythm-control, rate-control, frailty, older adults |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 05 Oct 2023 14:11 |
| Last Modified: | 05 Oct 2023 14:11 |
| DOI: | 10.3389/fcvm.2022.1050744 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3173470 |
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