Abstract
Conflicting results have been reported on the impact of frailty on adverse outcomes in patients with atrial fibrillation (AF). The aim of this meta-analysis was to evaluate the impact of frailty on death and major bleeding in patients with AF.
We comprehensively searched PubMed and Embase databases until June 30, 2021 for the relevant studies that investigated the impact of frailty on all-cause mortality and major bleeding in AF patients. Pooled multivariable-adjusted risk ratio (RR) and 95% confidence intervals (CI) was estimated for the frail vs. nonfrail patients using a random-effect model.
Ten studies involving 97,413 patients with AF satisfied the inclusion criteria. The prevalence of frailty in patients with AF ranged between 5.9% and 89.5%. Meta-analysis indicated that frailty was associated with higher risk of all-cause mortality (RR 2.77; 95% CI 1.68–4.57) and major bleeding (RR 1.83; 95% CI 1.24–2.71). Subgroup analysis showed that the impact of frailty on all-cause mortality was consistently found in each subgroup.
Frailty independently predicts all-cause mortality and major bleeding in patients with AF. Determination of frailty status may play an important role in risk classification of AF patients. However. lack of standardized definition of frailty is the most important limitations of this meta-analysis.
•The role of frailty in predicting death and major bleeding in patients with AF is conflicting.•AF patients with frailty conferred a 2.77-fold higher risk of all-cause mortality.•AF patients with frailty conferred a 1.83-fold higher risk of major bleeding.•Frailty should be recommended in risk stratification in AF patients.•Lack of standardized definition of frailty is the most important limitations.