Sarcopenia, frailty, cognitive impairment and mortality in elderly patients with non-valvular atrial fibrillation

M A Requena Calleja; A Arenas Miquélez; J Díez-Manglano; A Gullón; A Pose; F Formiga; J M Mostaza; J M Cepeda; C Suárez; en nombre de los investigadores del estudio NONAVASC; Grupo de Riesgo Vascular de la Sociedad Española de Medicina Interna

doi:10.1016/j.rce.2019.04.001

Sarcopenia, frailty, cognitive impairment and mortality in elderly patients with non-valvular atrial fibrillation

Rev Clin Esp (Barc). 2019 Nov;219(8):424-432. doi: 10.1016/j.rce.2019.04.001. Epub 2019 May 18.

[Article in English, Spanish]

Affiliations

¹ Departamento de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España.
² Departamento de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España. Electronic address: jdiez@aragon.es.
³ Departamento de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España.
⁴ Departamento de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España.
⁵ Departamento de Medicina Interna, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
⁶ Departamento de Medicina Interna, Hospital Carlos III, Madrid, España.
⁷ Departamento de Medicina Interna, Hospital Vega Baja, Orihuela, Alicante, España.

PMID: 31109685
DOI: 10.1016/j.rce.2019.04.001

Abstract

Objectives: To determine the prevalence of sarcopenia, frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation (NVAF) and the factors' influence on survival.

Methods: Prospective, multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain. For each patient, we recorded the creatinine, haemoglobin and platelet levels, the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index, as well as the use of oral anticoagulants. We measured sarcopenia with the SARC-F scale, frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire. We also conducted a 1-year follow-up.

Results: The study included 596 patients with NVAF, with a mean age of 84.9 (SD: 5.2) years. Of these, 295 (49.5%) presented sarcopenia, 305 (51.2%) presented frailty, and 251 (42.1%) presented cognitive impairment. At the end of 1year, 226 (37.9%) patients had died. Mortality was greater for the patients with sarcopenia, frailty and cognitive impairment. In the multivariate analysis, sarcopenia (HR: 1.775; 95%CI: 1.270-2.481), age, comorbidity and a history of peripheral embolism were associated with increased mortality, and the use of oral anticoagulants at discharge (HR: 0.415; 95%CI: 0.307-0.560) was associated with lower mortality.

Conclusions: Sarcopenia, frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated. Sarcopenia was associated with increased mortality.

Keywords: Ancianos; Atrial fibrillation; Cognitive impairment; Cohort study; Deterioro cognitivo; Elderly; Estudio de cohortes; Fibrilación auricular; Fragilidad; Frailty; Mortalidad; Mortality; Sarcopenia.