Prevalence and Impact of Atrial Fibrillation on Intra-Hospital Mortality in Patients Aged ≥75 Years.

It is unclear whether the association between atrial fibrillation (AF) and intra-hospital mortality in patients aged 75 years and older is causal or not. This study aims (1) to describe the prevalence and clinical characteristics of AF in ≥75-year-old inpatients and (2) to study the association between AF and length of stay (LOS) and intra-hospital mortality. This retrospective cohort study includes consecutive patients aged ≥75 years admitted between January 2017 and December 2019 to a Belgian secondary hospital. Survival analysis was conducted on the whole dataset and a propensity score-matched dataset separately. Propensity score matching (PSM) was performed to account for the individual probability of having AF given a set of covariates. In 9,105 patients, 3,137 (34%) had a diagnosis of AF upon hospital admission. AF prevalence increased with age strata (from 29% to 38%), and Charlson Co-morbidity Index (from 28% to 57%). Intra-hospital mortality (20%) was higher in the AF group than in the AF-free group (25% vs 17%, p <0.001). The median LOS was 11 days and was shorter in those without AF (10 [4, 17] days) compared with those with AF (11 [5, 19], p <0.001). After PSM, AF was not associated with increased odds of LOS >10 days (odds ratio 1.08, confidence interval: 0.98 to 1.20, p = 0.13). The risk of intra-hospital death for patients with AF remained higher compared with those without AF (log-rank p = 0.0015 and hazard ratio 1.17; confidence interval: 1.04 to 1.32, p = 0.008). In conclusion, the prevalence of AF was high (34%) in inpatients aged ≥75 years and increased with age and co-morbidity burden. After PSM, patients with AF had a 17% higher risk of intra-hospital mortality than patients without AF.

Association between atrial fibrillation, frailty, and geriatric syndromes in the late elderly in a south Belgian outpatient and inpatient setting.

Study objective: This study aims to analyze the relationship between AF, frailty, and geriatric syndromes in elderly patients in an outpatient and inpatient setting in a South Belgian hospital. Participants design and setting: This is a single center case-control retrospective study including 207 patients enrolled from an outpatient and inpatient setting of the Department of Geriatrics, Jolimont Hospital Group. Frailty was assessed using a complete geriatric assessment and Rockwoods Clinical Frailty Scale. Results: AF was strongly associated with age, cardiovascular history, congestive heart failure, as well as with multiple geriatric syndromes such as vascular dementia, malnutrition, functional decline in Activities of Daily Living, mobility impairment and chronic ulcerous disease. Furthermore, there was a tight relationship between AF and Rockwoods' frailty phenotypes. This association was maintained throughout multivariable modelling including age (OR 1.06, IC 1.03-1.14, p = 0.042), sex (OR 2.30, IC 1.11-4.84, p = 0.026), congestive heart failure (OR 3.70, IC 1.77-7.91, p < 0.001) and a CFS more than 4 (OR 2.68, IC 1.18-6.43, p = 0.021). Conclusion: A deeper understanding of associations between atrial fibrillation and geriatric syndromes and frailty could give new patient management perspectives beyond pharmaceutical or interventional treatment.