Abstract 15724: All-Cause Death and Major Adverse Events in Atrial Fibrillation With Frailty: Observations From the Korea National Health Insurance Service Data

Abstract

Introduction: Atrial fibrillation (AF) may be a marker of frailty. Previous evidence indicated that frailty in patients with AF has been associated with increased adverse events. Hypothesis: This study aimed to investigate the effect of frailty on the use of oral anticoagulants (OAC) and clinical outcomes in a nationwide cohort of patients with AF. Methods: We included 451,368 participants without AF from the Korea National Health Insurance Service-Health Screening cohort from 2005 to 2010. Patients’ Hospital Frailty Risk Score was calculated and patients were divided into two groups: without frailty (< 5 points) and with frailty (≥ 5 points). Results: Over 7.2 years, 11,953 participants (median age, 67 years; 60.2% men) developed new-onset AF. Among these patients, 26.9% had frailty. Frailty was significantly associated with older age, female sex, polypharmacy, and comorbidities. Frailty was negatively associated with OAC prescription after new-onset AF ( P < 0.001). Patients with frailty had significantly higher risk of all-cause death (hazard ratio [HR] 2.87, 95% confidence interval [CI] 2.66-3.11), cardiovascular death (HR 2.60, 95% CI 2.77-2.98), stroke (HR 2.49, 95% CI 2.25-2.75), major bleeding (HR 2.54, 95% CI 2.28-2.83), and heart failure admission (HR 1.30, 95% CI 1.11-1.53). The increased risks of all-cause death, cardiovascular death, stroke, and heart failure admission due to frailty were lower with OAC prescription. Conclusions: Frailty was negatively associated with OAC use and was a predictor of worse prognosis. However, the increased risks associated with frailty were reduced by OAC in patients with AF.