Impact of frailty on early rhythm control outcomes in older adults with atrial fibrillation: A nationwide cohort study

Ga In Yu, Daehoon Kim, Jung Hoon Sung, Eunsun Jang, Hee Tae Yu, Tae Hoon Kim, Hui Nam Pak, Moon Hyoung Lee, Gregory Y.H. Lip, Pil Sung Yang, Boyoung Joung

Research output: Contribution to journalArticlepeer-review


Purpose: Rhythm-control therapy administered early following the initial diagnosis of atrial fibrillation (AF) has superior cardiovascular outcomes compared to rate-control therapy. Frailty is a key factor in identifying older patients’ potential for improvement after rhythm-control therapy. This study evaluated whether frailty affects the outcome of early rhythm-control therapy in older patients with AF. Methods: From the Korean National Health Insurance Service database (2005–2015), we collected 20,611 populations aged ≥65 years undergoing rhythm- or rate-control therapy initiated within 1 year of AF diagnosis. Participants were emulated by the EAST-AFNET4 trial, and stratified into non-frail, moderately frail, and highly frail groups based on the hospital frailty risk score (HFRS). A composite outcome of cardiovascular-related mortality, myocardial infarction, hospitalization for heart failure, and ischemic stroke was compared between rhythm- and rate-control. Results: Early rhythm-control strategy showed a 14% lower risk of the primary composite outcome in the non-frail group [weighted incidence 7.3 vs. 8.6 per 100 person-years; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.79–0.93, p < 0.001] than rate-control strategy. A consistent trend toward a lower risk of early rhythm-control was observed in the moderately frail (HR 0.91, 95% CI 0.81–1.02, p = 0.09) and highly frail (HR 0.93, 95% CI 0.75–1.17, p = 0.55) groups. Conclusion: Although the degree attenuated with increasing frailty, the superiority of cardiovascular outcomes of early rhythm-control in AF treatment was maintained without increased risk for safety outcomes. An individualized approach is required on the benefits of early rhythm-control therapy in older patients with AF, regardless of their frailty status.

Original languageEnglish
Article number1050744
JournalFrontiers in Cardiovascular Medicine
Publication statusPublished - 2023 Jan 6

Bibliographical note

Funding Information:
This work was supported by a grant from the Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health and Welfare, Republic of Korea (grant number: HC19C0130). The funders had no role in the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit the report for publication.

Publisher Copyright:
Copyright © 2023 Yu, Kim, Sung, Jang, Yu, Kim, Pak, Lee, Lip, Yang and Joung.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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