All-Cause Death and Major Adverse Events in Atrial Fibrillation with Frailty: Observations from the Korea National Health Insurance Service Data

J. Park, Pil‐Sung Yang, Daehoon Kim, J. Sung, E. Jang, H. Yu, Tae‐Hoon Kim, H. Pak, Moon‐Hyoung Lee, B. Joung
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Abstract

Background : Atrial fibrillation (AF) is an indicator of frailty in old patients. 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 new-onset AF. Methods : This study included 451,368 participants without AF from the Korea National Health Insurance Service-Health Screening cohort between 2002 and 2009. The Hospital Frailty Risk Score was retrospectively calculated for each patient using all available International Classification of Disease 10th revision diagnostic codes. According to the aggregate score, patients were divided into two groups: the participants without frailty ( < 5 points) and the participants with frailty ( ≥ 5 points). The primary outcome was death from any cause, and the secondary outcomes were cardiovascular death, ischemic stroke, major bleeding, and heart failure admission. Results : With up to 7.2 ± 1.5 years of follow-up, 11,953 participants (median age, 67 [interquartile range, 59.5–74.5] years; 7200 [60.2%] males) developed new-onset AF. Among the patients with AF, 3224 (26.9%) had frailty. Frailty was significantly associated with old age, female sex, polypharmacy, and other comorbidities. In patients with AF, frailty was negatively associated with OAC prescription after new-onset AF ( p < 0.001). Compared to patients without frailty, patients with frailty had a significantly higher incidence and risk of all-cause death (hazard ratio [HR] 2.88, 95% confidence interval [CI] 2.65–3.14), cardiovascular death (HR 2.42, 95% CI 2.10–2.80), ischemic stroke (HR 2.25, 95% CI 2.02–2.51), major bleeding (HR 2.44, 95% CI 2.17–2.73), and heart failure admission (HR 1.29, 95% CI 1.09–1.52). In subgroup analysis, when compared to the non-OAC group, the risks associated with frailty were significantly lower in the OAC group for all-cause death, cardiovascular death, ischemic stroke, and heart failure admission. Conclusions : Frailty was negatively associated with the use of OAC and was a predictor of poor prognosis owing to the association of frailty with death, thromboembolic events, bleeding, and heart failure admission. However, OAC use was associated with lower risks related to frailty for all-cause death and major adverse cardiovascular events in patients with AF.
伴有虚弱的心房颤动患者的全因死亡和主要不良事件:韩国国民健康保险服务数据观察
背景:心房颤动(房颤)是老年患者体弱的一个指标。本研究旨在调查体弱对新发房颤患者口服抗凝药(OAC)的使用和临床结果的影响。方法:该研究纳入了 2002 年至 2009 年期间韩国国民健康保险服务-健康筛查队列中的 451 368 名无房颤患者。采用所有可用的《国际疾病分类》第 10 次修订版诊断代码,回顾性地计算出每位患者的医院虚弱风险评分。根据总分,患者被分为两组:无虚弱(< 5 分)和有虚弱(≥ 5 分)。主要结果为任何原因导致的死亡,次要结果为心血管死亡、缺血性中风、大出血和心力衰竭入院。结果:在长达 7.2 ± 1.5 年的随访中,有 11953 名参与者(中位年龄 67 [四分位间范围 59.5-74.5] 岁;男性 7200 [60.2%])患上了新发房颤。房颤患者中有 3224 人(26.9%)体弱。体弱与年龄、女性性别、多种药物治疗和其他合并症有明显关联。在心房颤动患者中,体弱与新发心房颤动后的 OAC 处方呈负相关(P < 0.001)。与不虚弱的患者相比,虚弱患者全因死亡(危险比 [HR] 2.88,95% 置信区间 [CI] 2.65-3.14)、心血管死亡(HR 2.42,95% CI 2.10-2.80)、缺血性卒中(HR 2.25,95% CI 2.02-2.51)、大出血(HR 2.44,95% CI 2.17-2.73)和心力衰竭入院(HR 1.29,95% CI 1.09-1.52)的发生率和风险明显更高。在亚组分析中,与非 OAC 组相比,在全因死亡、心血管死亡、缺血性中风和心力衰竭入院方面,OAC 组与虚弱相关的风险显著降低。结论 :由于虚弱与死亡、血栓栓塞事件、出血和心力衰竭入院有关,因此虚弱与 OAC 的使用呈负相关,是预后不良的预测因素。然而,在房颤患者中,使用 OAC 与体弱有关的全因死亡和主要不良心血管事件的风险较低。
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