Background and aims: Atrial fibrillation (AF) is more common with increasing age and older adults have greater prevalence of frailty, multimorbidity and polypharmacy, which may impact clinical outcomes. The present study aims to investigate the relationship between frailty and the risk of hospitalization for AF in older adults, and second, the possible interaction of multimorbidity in this association.
Methods and results: Data from the Progetto Veneto Anziani (Pro.V.A.), an observational cohort study in north-eastern Italy, were utilised. The analyses included 2909 individuals aged ≥65 years without AF at baseline, assessed between 1995 and 1997, with follow-ups at 4.4 and 7 years. Frailty was defined according to Fried's criteria, and multimorbidity as the number of chronic diseases. AF-related hospitalizations and deaths were recorded up to December 31, 2018. Multi-adjusted mixed-effects Cox regressions were performed to test associations. Over the follow-up period, 318 (10.9 %) participants experienced AF-related hospitalizations. Compared to robust participants, the hazard ratio (HR) of hospitalizations due to AF was 1.42 (95 % Confidence Interval (95 %CI): 1.04-1.95) in pre-frail and 1.98 (95 %CI: 1.21-3.26) in frail individuals, even after adjusting for multimorbidity. The number of chronic diseases was only marginally and not significantly associated with AF-related hospitalizations (HR 1.07, 95 %CI: 0.99-1.15), but did not significantly interact with frailty in the association with AF-related hospitalizations.
Conclusion: Older adults with frailty present with higher hazards of AF-related hospitalizations, irrespective of the presence of multimorbidity. Further studies are needed to evaluate whether reducing frailty may prevent AF development and improve health outcomes in older adults.
Keywords: AFFIRMO project; Atrial fibrillation; Frailty; Hospitalization; Multimorbidity.
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