Modified Frailty as a Novel Factor in Predicting the Maintenance of the Sinus Rhythm After Electrical Cardioversion of Atrial Fibrillation in the Elderly Population

Frailty and Cardiovascular Health

The incidence of frailty and cardiovascular disease (CVD) increases as the population ages. There is a bidirectional relationship between frailty and CVD, and both conditions share several risk factors and underlying biological mechanisms. Frailty has been established as an independent prognostic marker in patients with CVD. Moreover, its presence significantly influences both primary and secondary prevention strategies for adults with CVD while also posing a barrier to the inclusion of these patients in pivotal clinical trials and advanced cardiac interventions. This review discusses the current knowledge base on the relationship between frailty and CVD, how managing CVD risk factors can modify frailty, the influence of frailty on CVD management, and future directions for frailty detection and modification in patients with CVD.

Comparison of the Value of Four Objective Nutritional Indices in Assessing the Long-Term Prognosis of Elderly Patients with Heart Failure with Preserved Ejection Fraction

Background

The long-term prognosis of heart failure with preserved ejection fraction (HFpEF) is influenced by malnutrition. Currently, there's a deficit in objective and comprehensive nutritional assessment methods to evaluate the nutritional status and predicting the long-term outcomes of HFpEF patients.

Methods

Our retrospective study included two hundred and eighteen elderly HFpEF patients admitted to the cardiovascular ward at the Air Force Medical Centre from January 2016 to December 2021. Based on follow-up outcomes, patients were categorized into all-cause death (99 cases) and Survival (119 cases) groups. We compared general data, laboratory results, and nutritional indexes between groups. Differences in subgroups based on Triglyceride-Total Cholesterol-Body Weight Index (TCBI), Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlled Nutrition Score (CONUT) were analyzed using Kaplan-Meier survival curves and log-rank test. COX regression was used to identify all-cause mortality risk factors, and the predictive accuracy of the four nutritional indices was assessed using receiver operating characteristic (ROC) curves and Delong test analysis.

Results

A total of 101 (45.41%) HFpEF patients experienced all-cause mortality during 59.02 ± 1.79 months of follow-up. The all-cause mortality group exhibited lower GNRI and PNI levels, and higher CONUT levels than the Survival group (p < 0.05). Kaplan-Meier analysis revealed lower cumulative survival in the low GNRI ( ≤ 96.50) and low PNI ( ≤ 43.75) groups, but higher in the low CONUT ( ≤ 2) group, compared to their respective medium and high-value groups. Multifactorial COX regression identified low PNI ( ≤ 43.75) as an independent all-cause mortality risk factor in elderly HFpEF patients. ROC and Delong's test indicated PNI (area under the curve [AUC] = 0.698, 95% confidence interval [CI] 0.629-0.768) as a more effective predictor of all-cause mortality than TCBI (AUC = 0.533, 95% CI 0.456-0.610) and CONUT (AUC = 0.621, 95% CI 0.547-0.695; p < 0.05). However, there was no significant difference compared to GNRI (AUC = 0.663, 95% CI 0.590-0.735; p > 0.05).

Conclusions

In elderly HFpEF patients a PNI ≤ 43.75 was identified as an independent risk factor for all-cause mortality. Moreover, PNI demonstrates superior prognostic performance in predicting all-cause mortality in elderly patients with HFpEF when compared to TCBI, GNRI, and COUNT.

Implication of different frailty criteria in older people with atrial fibrillation: a prospective cohort study

BACKGROUND

the prevalence of physical and multidimensional frailty and their prognostic impact on clinical outcomes in patients with atrial fibrillation (AF) is unclear.

OBJECTIVE

to evaluated frailty in a cohort of patients with AF according to different criteria, and studied the prevalence and its prognostic impact on clinical outcomes.

METHODS

in this multicenter prospective cohort, 197 inpatients ≥ 65 years old with AF were recruited from September 2018 to April 2019.We used Fried Frailty phenotype (Fried) to assess physical frailty, and comprehensive geriatric assessment-frailty index (CGA-FI) to assess multidimensional frailty. The primary outcome was a composite of all-cause mortality or rehospitalization.

RESULTS

the prevalence of frailty was determined as 34.5% by Fried, 42.6% by CGA-FI. Malnutrition and ≥ 7 medications were independently associated with frailty. Kaplan-Meier survival curve showed that the presence of frailty by CGA-FI had significantly lower all-cause mortality or rehospitalization survival rate (log-rank P = 0.04) within 1 year. Multivariate Cox regression adjusted for age and sex showed that the frailty by CGA-FI was significantly associated with the risk of all-cause mortality or rehospitalization within 1 year (HR 1.79, 95% CI 1.10-2.90). However, those associations were absent with the physical frailty. After broader multivariate adjustment, those associations were no longer statistically significant for both types of frailty.

CONCLUSIONS

in older people with AF, Multidimensional frailty is more significantly associated with a composite of all-cause mortality or rehospitalization within 1 year than physical frailty, but these association are attenuated after multivariate adjustment.

CLINICAL TRIAL REGISTRATION

ChiCTR1800017204; date of registration: 07/18/2018.

Describing the relationship between atrial fibrillation and frailty: Clinical implications and open research questions

In the recent years a lot of attention has been gathered by the issue of frailty outside the boundaries of the geriatric medicine, for example in the field of cardiovascular medicine. Atrial fibrillation (AF) is known as a very common cardiological condition, often burdened by high level of clinical complexity. Aim of this narrative review is to examine the most relevant evidence about the relationship between frailty and AF, focusing also on its impact on clinical management and natural history of patients with this condition. Data reported underline how a relevant relationship exists between these two conditions, even though the burden of frailty among AF cohorts is still unclear. Frailty seems to affect the clinical management, even though no definitive data are yet available. Lastly, frailty significantly increases the risk of all-cause mortality but it's still unclear the impact on thromboembolic and bleeding events. Despite several data are already available, more research is still needed to fully elucidate the relationship between these two clinical entities.