Atrial fibrillation and clinical frailty are associated in older patients with severe aortic stenosis
(2022) EuGMS — Location: London (28.September.2022)
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- Background: It has been suggested that patients with atrial fibrilla- tion (AF) are sicker patients with poorer cardiovascular health thereby explaining higher morbidity and mortality following Transcatheter Aortic Valve Replacement (TAVR). This study aimed at investigating whether clinical frailty is associated to AF independently of cardio- vascular co-morbidities. Methods: Retrospective study of consecutive older patients (C 75 years) with comprehensive cardiac and geriatric assessments at our university hospital before a TAVR (2012–2019). Data were col- lected to allow the calculation of several scores: CHADS2, MNA-SF and clinical frailty scale (CFS). 2-year mortality was studied with Kaplan-Meier. Associations between AF pre-existing to TAVR, and frailty (CFS C 5) were addressed using uni- and multivariable logistic regression analyses. Results: Of the 345 patients (mean age 86 ± 4.4 years, 54% women), 129 presented with AF (37%) during the pre-TAVI assessment. Those patients with AF died more frequently within two years after TAVR (OR: 1.85, p = 0.014, Log-rang p = 0.017). In univariate analyses, AF showed a strong statistical association (p \ 0.01) with pulmonary hypertension (OR 3.49), pacemaker (OR 2.49), congestive heart failure (OR 2.17), CHADS2 score (OR 1.46, per unit), C 5 daily drugs (OR 2.84), frailty (OR 1.90) and albuminemia (OR 0.91, per g/L). In multivariate analysis, AF remained significantly associated (p\0.05) with ischemic disease (OR 0.58), CHADS2 score (OR 1.46, per unit) and clinical frailty (OR 1.74). Conclusion: Clinical frailty was associated to AF in older patients with severe aortic valve stenosis independently of cardiovascular co- morbidities, and may thereby participate in explaining the association between AF and mortality following TAVR.
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de Terwangne, C., Maes, F., & Boland, B. (2022). Atrial fibrillation and clinical frailty are associated in older patients with severe aortic stenosis. European Geriatric Medicine, 13, 1-439. https://hdl.handle.net/2078.5/218582 (Original work published 2022)