The impact of subjective vs objective frailty on the effectiveness and safety outcomes in patients from ETNA-AF-Europe registry

Abstract

Abstract Background Since the risk of atrial fibrillation (AF) increases with ageing, frail patients tend to require long-term anticoagulation. Anticoagulated frail patients may be at increased risk of major bleeding, which becomes more frequent in the elderly. Therefore, oral anticoagulation is often withheld or discontinued in frail, older patients with AF. Purpose To compare patient characteristics and annualised stroke and bleeding event rates in subjectively and objectively frail patients in the overall population included in the ETNA-AF-Europe registry. The 1-year follow-up was based on a snapshot dated 31st October 2019. Methods ETNA-AF-Europe is a multinational, multicentre, post-authorisation, observational study conducted in patients with AF following an edoxaban treatment regimen. Subjective frailty was categorised using a yes/no option, as perceived by physicians as a personal global judgement, without any external interference. Objective frailty was assessed using an adapted Modified Frailty Index; a shortened, simplified version of the Frailty Index. Results ETNA-AF Europe compiled data from 13,092 patients treated with edoxaban once daily, 10.6% and 5.0% were classified as subjectively and objectively frail, respectively (Table 1). Patients classified as objectively frail were younger, had a higher body mass index and higher CHA2DS2-VASc and HAS-BLED scores compared with the subjectively frail patients (Table 1), showing minimal overlap between the two groups. Stroke, major bleeding, all-cause and cardiovascular deaths were higher in patients classified as frail (Figure 1). Annualised event rates were mostly comparable in subjectively and objectively frail patients, except for higher annualised rates of ischaemic stroke, observed in subjectively frail patients, and higher annualised rates of myocardial infarction in objectively frail patients (Figure 1). The adherence to drug recommendations was similar in the subjectively and objectively frail cohorts (78.0% and 79.1%, respectively), but lower than in the general AF population (82.9%) (Table 1). Conclusions The presence of frailty (either subjective or objective) predicts cardiovascular events in anticoagulated patients with AF. A comprehensive assessment of frailty could improve the routine care of patients with AF. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Europe GmbH