Evidence map›Paper›PMID 30445608›Full record

SynthesisAge and ageing2019

Management of atrial fibrillation for older people with frailty: a systematic review and meta-analysis.

Chris Wilkinson, Oliver Todd, Andrew Clegg, Chris P Gale, Marlous Hall

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Age and ageing, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 78 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
78citing papers in PubMed, 4 pooled it
6.1field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

78 citing papers in PubMed, 4 syntheses or guidelines pooled it, 145 citations in OpenAlex.

  1. Pooled it
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  13. Frailty and Cardiovascular Risk.European cardiology · 2026
    Review
  14. Article
  15. Direct oral anticoagulants in very elderly and high-bleeding-risk patients with atrial fibrillation often excluded from oral anticoagulation therapy: a nationwide population-based cohort study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025
    Article
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18 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

Chris WilkinsonDepartment of Clinical and Population Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, UK.
Oliver ToddAcademic Unit of Eldery Care and Rehabilitation, Bradford Institute for Health Research, University of Leeds, Bradford Royal Infirmary, Duckworth Lane, Bradford, UK.
Andrew CleggAcademic Unit of Eldery Care and Rehabilitation, Bradford Institute for Health Research, University of Leeds, Bradford Royal Infirmary, Duckworth Lane, Bradford, UK.
Chris P GaleDepartment of Clinical and Population Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, UK.
Marlous HallDepartment of Clinical and Population Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, UK.
University of Leeds · GBBradford Royal Infirmary · GB

Funding

Dunhill Medical Trust RTF107/0117The Dunhill Medical Trust RTF107/0117Wellcome Trust 206470/Z/17/Z
6 · The paper itself

Abstract

backgrounddespite a large and growing population of older people with frailty and atrial fibrillation (AF), there is a lack of guidance on optimal AF management in this high-risk group.

objectiveto synthesise the existing evidence base on the association between frailty, AF and clinical outcomes.

methodsa systematic review of studies examining the association between validated measures of frailty, AF and clinical outcomes, and meta-analysis of the association between frailty and oral anticoagulation (OAC) prescription.

resultstwenty studies (30,883 patients) were included, all observational. Fifteen were in hospital, four in the community, one in nursing care. Risk of bias was low-to-moderate. AF prevalence was 3%-38%. In people with AF, frailty was associated with increased stroke incidence, all-cause mortality, symptom severity and length of hospital stay.Meta-analysis of six studies showed frailty was associated with decreased OAC prescription at hospital admission (pooled adjusted OR 0.45 [95%CI 0.22-0.93], three studies), but not at discharge (pooled adjusted OR 0.40 [95%CI 0.13-1.23], three studies). A community-based study showed increased OAC prescription associated with frailty (OR 2.33 [95%CI 1.03-5.23]).

conclusionfrailty is common, and associated with adverse clinical outcomes in patients with AF. There is evidence of an association between frailty status and OAC prescription, with different direction of effect in community compared with hospital cohorts. Despite the majority of care for older people being provided in the community, there is a lack of evidence on the association between frailty, AF, anticoagulation and clinical outcomes to guide optimal care in this setting.

Indexed as

Frail ElderlyAgedAnticoagulantsAtrial FibrillationHumansTreatment OutcomeAnticoagulantsanticoagulationatrial fibrillationfrailtyolder peoplesystematic review

Identifiers

PMID30445608
PMCPMC6424377
OpenAlexW2901264117

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.