Frailty and advanced age in atrial fibrillation: Implications for treatment strategies and clinical outcomes - A systematic review.

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal Pub Date : 2026-04-17 DOI:10.1016/j.ihj.2026.04.006

Akash Batta, Razieh Parizad, Juniali Hatwal, Ankur Mittal, Manjeet Kumar Goyal, Bishav Mohan

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引用次数: 0

Abstract

Background: Atrial fibrillation (AF) is common among frail older adults and poses complex management challenges due to reduced physiological reserve and heightened vulnerability to adverse outcomes.

Aims: This systematic review (2015-2025) examined influence of frailty and advanced age on AF management and outcomes, focusing on anticoagulation, interventional therapies and quality of life.

Methods: Eligible cohort studies, trials, meta-analyses assessed outcomes including mortality, stroke, major bleeding, functional decline, recurrence, healthcare costs and quality of life with frailty measured using validated tools like Clinical Frailty Scale.

Results: Frail patients had a two-to threefold higher mortality risk and 40-50% greater incidence of stroke and major bleeding than non-frail peers. Low-dose NOACs reduced stroke in frail octogenarians but bleeding risk persisted. Rate control therapy improved symptoms yet increased hypotension risk. Catheter ablation showed lower success and more complications.

Conclusions: Severe frailty and age ≥85 were associated with poorer outcomes, higher resourcutilization and reduced quality of life.

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房颤的虚弱和高龄：对治疗策略和临床结果的影响-一项系统综述。

房颤（AF）常见于体弱的老年人，由于生理储备减少和对不良后果的易感性增加，心房颤动（AF）提出了复杂的管理挑战。本系统综述（2015-2025）研究了虚弱和高龄对房颤管理和结果的影响，重点关注抗凝、介入治疗和生活质量。符合条件的队列研究、试验、荟萃分析评估的结果包括死亡率、中风、大出血、功能下降、复发、医疗成本和生活质量，并使用临床虚弱量表等有效工具测量虚弱。体弱患者的死亡风险比非体弱患者高2 - 3倍，中风和大出血的发生率比非体弱患者高40-50%。低剂量NOACs可降低体弱的八旬老人的中风，但出血风险持续存在。速率控制疗法改善了症状，但增加了低血压的风险。导管消融成功率较低，并发症较多。严重虚弱和年龄≥85岁与较差的结果、较高的利用率和降低的生活质量相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Indian heart journal CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.60

自引率

6.70%

发文量

审稿时长

52 days

期刊介绍： Indian Heart Journal (IHJ) is the official peer-reviewed open access journal of Cardiological Society of India and accepts articles for publication from across the globe. The journal aims to promote high quality research and serve as a platform for dissemination of scientific information in cardiology with particular focus on South Asia. The journal aims to publish cutting edge research in the field of clinical as well as non-clinical cardiology - including cardiovascular medicine and surgery. Some of the topics covered are Heart Failure, Coronary Artery Disease, Hypertension, Interventional Cardiology, Cardiac Surgery, Valvular Heart Disease, Pulmonary Hypertension and Infective Endocarditis. IHJ open access invites original research articles, research briefs, perspective, case reports, case vignette, cardiovascular images, cardiovascular graphics, research letters, correspondence, reader forum, and interesting photographs, for publication. IHJ open access also publishes theme-based special issues and abstracts of papers presented at the annual conference of the Cardiological Society of India.