Abstract 13613: Combination of Atrial Fibrillation and Frailty: Association With All-cause Mortality in Older Veterans

Abstract

Background: Atrial fibrillation (AF), the commonest arrhythmia among older adults, is associated with increased mortality. Frailty constitutes a state of vulnerability to stressors resulting from multisystemic loss of physiological reserve. The study aim was to determine whether concurrent frailty and AF increases all-cause mortality in older Veterans. Methods: Retrospective cohort study of community-dwelling Veterans 60 years and older identified as having baseline AF (ICD codes) or frailty through a 30-item VA Frailty Index (VA-FI). The VA-FI was generated as a proportion of morbidity, function, sensory loss, cognition/mood and other variables. The VA-FI categorized Veterans into non-frail (robust FI≤.10, prefrail FI=>.10,<.21) and frail (FI≥.21). The combination resulted in 4 groups: Neither AF nor frailty (NoAF-F), atrial fibrillation (AF), frailty (F), and AF and frailty (AF-F). At the end of follow-up, data on mortality was aggregated and adjusted for age, gender, race, ethnicity, marital status, and BMI, the association of concurrent AF and/or frailty with all-cause mortality was determined using a Cox regression model including testing for interaction effects. Results: A total of 16391 Veterans were included, mean age 72.06 (SD=9.23) years 74.2% White, 86.7% non-Hispanic, and 97.9% male. There were 1534 (9.4%) Veterans with AF and the proportion of robust, pre-frail and frail patients was 44.3% (n=7255), 37.2% (n=6095) and 18.6% (n=3041) respectively. The 4 resulting groups were NoAF-F (12357, 75.4%), AF (993, 6.1%), F (2500, 15.3%) and AF-F (541, 3.3%). Over a median follow-up of 2025 days (IQR=245) 3917 deaths occurred. As compared with NoAF-F, AF-F, F and AF in that order had higher all-cause mortality, adjusted hazard ratio (HR)=3.24 (95%CI:2.88-3.66), p<.0005; HR=2.06 (95%CI:1.90-2.22), p<.0005; and HR=1.47 (95%CI:1.31-1.64), p<.0005 respectively. When frailty and AF were considered jointly they did not interact. Conclusions: The combination of AF and frailty at baseline represents the group with highest risk for all-cause mortality in older Veterans. Further studies may be needed to assess the impact on mortality of clinical interventions targeting both conditions.