| Title: |
Impact of frailty on early rhythm control outcomes in older adults with atrial fibrillation: A nationwide cohort study |
| Authors: |
Yu, GI; Kim, D; Sung, JH; Jang, E; Yu, HT; Kim, TH; Pak, HN; Lee, MH; Lip, GYH; Yang, PS; Joung, B |
| Publisher Information: |
Frontiers Media SA |
| Publication Year: |
2023 |
| Collection: |
The University of Liverpool Repository |
| Description: |
Purpose: 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. Methods: 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. Results: 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, p < 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, p = 0.09) and highly frail (HR 0.93, 95% CI 0.75–1.17, p = 0.55) groups. Conclusion: 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. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| ISSN: |
2297-055X |
| Relation: |
https://livrepository.liverpool.ac.uk/3173470/1/Impact%20of%20frailty%20on%20early%20rhythm%20control%20outcomes%20in%20older%20adults%20with%20atrial%20fibrillation%20A%20nationwide%20cohort%20study.pdf; Collapse authors list. Yu, GI, Kim, D, Sung, JH, Jang, E, Yu, HT, Kim, TH, Pak, HN, Lee, MH, Lip, GYH orcid:0000-0002-7566-1626 , Yang, PS et al (show 1 more authors) and Joung, B (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-. ISSN 2297-055X, 2297-055X |
| DOI: |
10.3389/fcvm.2022.1050744 |
| Availability: |
https://livrepository.liverpool.ac.uk/3173470/; https://doi.org/10.3389/fcvm.2022.1050744; https://livrepository.liverpool.ac.uk/3173470/1/Impact%20of%20frailty%20on%20early%20rhythm%20control%20outcomes%20in%20older%20adults%20with%20atrial%20fibrillation%20A%20nationwide%20cohort%20study.pdf |
| Accession Number: |
edsbas.7E392E3B |
| Database: |
BASE |