Atrial fibrillation is the common arrhythmia in the elderly, and the average age of atrial fibrillation patients is rising. Elderly patients with atrial fibrillation have high incidence of thromboembolic complication and increasing age is associated with stroke severity. Assessing CHADS-VASc score is pivotal to evaluate substantial morbidity and mortality, especially regarding the increased risk of stroke. In addition, considering bleeding risk with HAS-BLED score is important to balance the benefit against the risk of bleeding. However in addition to CHADS-VASc and HAS-BLED score, the roll of frailty assessment in older atrial fibrillation patients is not known.Design and Method:
We evaluate 365 older (≥ 65 years old) atrial fibrillation patients who underwent comprehensive geriatric assessment (CGA) from 2007 to 2014 in a single tertiary hospital retrospectively. Taking anti-coagulant or anti-platelet agents on the point of CGA were reviewed. CHADS-VASc and HAS-BLED scores were calculated based on electronic medical records, and frailty index was computed from CGA. The primary outcome was the 3-year all-cause mortality.Results:
Patients with high CHADS-VASc score were more likely to be treated with anticoagulant rather than antiplatelet agent (P < 0.001). However, HAS-BLED score and frailty did not influence patients’ anti-thrombotic therapy. During the follow-up period (median [interquartile range], 31.8 [12.9–47.8] months), 153 patients (41.9%) died. Although frailty index was positively associated with CHADS-VASc score (P < 0.001) and HAS-BLED score (P < 0.012), frailty status was the only independent predictor for mortality after adjusting for confounders (hazard ratio, 4.007; 95% CI, 2.48–6.48; P < 0.001).Conclusions:
Frailty assessment along with CHADS-VASc and HAS-BLED score can provide fine resolution for predicting mortality in older atrial fibrillation patients.