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Frailty and outcomes in older adults with non-valvular atrial fibrillation from the ANAFIE registry.

  • Akishita, Masahiro1
  • Suzuki, Shinya2
  • Inoue, Hiroshi3
  • Akao, Masaharu4
  • Atarashi, Hirotsugu5
  • Ikeda, Takanori6
  • Koretsune, Yukihiro7
  • Okumura, Ken8
  • Shimizu, Wataru9
  • Tsutsui, Hiroyuki10
  • Toyoda, Kazunori11
  • Hirayama, Atsushi12
  • Yasaka, Masahiro13
  • Yamaguchi, Takenori11
  • Teramukai, Satoshi14
  • Kimura, Tetsuya15
  • Morishima, Yoshiyuki15
  • Takita, Atsushi16
  • Yamashita, Takeshi2
  • 1 Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: [email protected] , (Japan)
  • 2 The Cardiovascular Institute, Tokyo, Japan. , (Japan)
  • 3 Saiseikai Toyama Hospital, Toyama, Japan. , (Japan)
  • 4 Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. , (Japan)
  • 5 AOI Hachioji Hospital, Tokyo, Japan. , (Japan)
  • 6 Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan. , (Japan)
  • 7 National Hospital Organization Osaka National Hospital, Osaka, Japan. , (Japan)
  • 8 Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan. , (Japan)
  • 9 Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. , (Japan)
  • 10 Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan. , (Japan)
  • 11 Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. , (Japan)
  • 12 Osaka Police Hospital, Osaka, Japan. , (Japan)
  • 13 Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan. , (Japan)
  • 14 Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. , (Japan)
  • 15 Primary Medical Science Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan. , (Japan)
  • 16 Data Intelligence Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan. , (Japan)
Published Article
Archives of gerontology and geriatrics
Publication Date
Feb 19, 2022
DOI: 10.1016/j.archger.2022.104661
PMID: 35303601


We aimed to determine the proportion of frail patients among older adults with non-valvular atrial fibrillation (NVAF), characterize them and their use of anticoagulant therapy, and examine the association between frailty and clinical outcomes in a real-world setting using the ANAFIE Registry dataset. The target population consisted of more than 30,000 adults aged ≥75 years definitively diagnosed with NVAF by electrocardiogram. For this sub-cohort study, patients who answered the Kihon Checklist were registered prospectively. Patients were classified into robust, pre-frail, and frail groups based on the Kihon Checklist score. Of the 32,275 patients in the ANAFIE Registry, 2951 were enrolled in this subanalysis and responded to the Kihon Checklist: 959 (32.5%) patients were robust; 924 (31.3%), pre-frail; and 1068 (36.2%), frail. In the robust, pre-frail, and frail groups, respectively, the 2-year cumulative incidence rates of stroke/systemic embolic events were 2.4%, 3.3%, and 4.5%, (P = .025); all-cause death, 2.9%, 5.1%, and 13.7%, (P < .001); major bleeding, 1.5%, 1.2%, and 2.9%, (P = .029); and net clinical outcomes, 5.5%, 8.2%, and 17.1% (P < .001). Results were similar when comparing the robust+pre-frail vs frail groups. In multivariate analyses, cardiovascular death, all-cause death, and net clinical outcomes were significantly associated with frailty. In the robust+pre-frail vs frail groups, major bleeding was also associated with frailty. Frailty was associated with cardiovascular and all-cause death, net clinical outcomes, and major bleeding but not stroke or intracranial hemorrhage in older Japanese adults with NVAF. Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

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