Frailty in older adults with atrial fibrillation is multifactorial and associated with metabolic and cognitive factors
1. Among older adults with atrial fibrillation, higher homocysteine and C-reactive protein levels, poorer cognitive performance, and greater nutritional risk were independently associated with frailty.
Evidence Rating Level: 2 (Good)
Frailty affects about 40% of patients with atrial fibrillation (AF). While previous studies have examined individual factors related to frailty, research examining frailty status together with factors such as AF treatment patterns, inflammatory and metabolic markers, and cognitive and nutritional status is lacking. This study thus compared various clinical factors associated with frailty among robust, pre-frail, and frail patients. This retrospective cohort study included patients >60 years with AF admitted to a hospital (index admission) in China between January 2018 and December 2024. The primary outcome was frailty status at index admission. Among the 198 patients included, 28 (14.1%) were robust, 68 (34.3%) pre-frail, and 102 (51.5%) were frail. In total, 52 (26.3%) patients were newly diagnosed with AF, and 146 (73.7%) had pre-existing AF. Across the robust, pre-frail, and frail groups, functional and cognitive abilities decreased, nutritional risk increased, and homocysteine and C-reactive protein levels increased (all P < 0.001). In multivariable analyses, higher homocysteine levels (adjusted odds ratio (aOR) per 5-μmol/L increase, 1.34; 95% CI 1.09–1.65), higher C-reactive protein levels (adjusted OR per 5-mg/L increase, 1.15; 95% CI 1.02–1.31), lower cognitive scores (aOR per 1-point increase Montreal Cognitive Assessment score, 0.63; 95% CI 0.49–0.81), and higher Nutritional Risk Screening 2002 scores (aOR per 1-point increase, 2.28; 95% CI 1.58–3.28) were independently associated with frailty. Overall, this study found that among older adults with AF, higher homocysteine and C-reactive protein levels, poorer cognitive performance, and greater nutritional risk were independently associated with frailty. These findings highlight the importance of multidimensional frailty assessments to help identify vulnerable patients with AF.
Click here to read this study in the European Journal of Medical Research
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