Polypharmacy and cardiovascular co-morbidity as key contributors to frailty in geriatric patients with AF – insights of the Dutch-GERAF cohort study

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in older adults and is associated with increased morbidity and mortality. Frailty further exacerbates adverse health outcomes in AF patients. This study assessed the presence of impairments in geriatric domains in geriatric patients with AF and normal sinus rhythm (SR). This prospective, multicenter cohort study included patients aged ≥ 65 years from six geriatric outpatient clinics in the Netherlands. A comprehensive geriatric assessment (CGA) was performed to evaluate frailty, polypharmacy, cognitive function, functional status, physical, and social status. Frailty was assessed using a CGA-based Frailty Index (FI). Patients were categorized as robust (FI 0.25). Geriatric domains include somatic (polypharmacy), cognitive, physical, social and functional dependence. Multivariate logistic regression was performed to assess the association between AF and geriatric domain impairments adjusted for age, sex, stroke and heart failure. A total of 952 patients were included, of whom 197 (21%) had established AF, and 755 had SR. AF patients were older (median 81; Inter Quartile Range (IQR) 77–86 vs. 78 years; IQR 74–83, p < 0.001) and had higher rates of cardiovascular comorbidities, including heart failure (26% vs. 3%, p < 0.001) and stroke (26% vs. 19%, p = 0.024). Frailty was significantly more prevalent in AF patients (49% vs. 28%, p < 0.001), with a higher mean Frailty Index (0.19 vs. 0.15, p < 0.001). Patients with AF had higher odds of having polypharmacy (≥5 drugs) (adjusted odds ratio (OR) 3.01; 95%-confidence interval (CI) 1.98–4.59) and hyperpolypharmacy (≥ 10 drugs) (adjusted OR 2.67; 95%-CI 1.73–4.10). There was a trend between AF and physical problems (a composite of gait disturbances, falls, use of walking aids or decreased hand grip strength) (unadjusted OR 1.39; 95%-CI 0.99–1.94, mainly explained by the significant association between AF and the use of a walking device aOR 1.80, 95%-CI 1.20–2.71). The association between AF and functional dependence in activities of daily living (ADL) or Instrumental Activities of Daily Living (iADL) (unadjusted OR 1.44; 95%-CI 1.06–1.97), was not significant anymore after adjustment for age and sex. AF was not associated with other geriatric domains. Patients with AF have a higher prevalence of frailty compared with those in SR. Polypharmacy was the largest difference between AF and SR patients, and it seems that comorbidities, in particular cardiovascular comorbidities, appear to largely account for the higher frailty index in AF patients. Our findings suggest that within an already frail geriatric population, AF is associated with a distinct profile characterized by high cardiovascular comorbidity and polypharmacy, without conferring additional risk across cognitive, physical, or social domains. reference number 2019–5889 2020-04-15. ClinicalTrials.gov ID: NCT05337202.