Impact of frailty on outcomes of elderly patients with atrial fibrillation: A systematic review and meta-analysis.

Objective: Atrial fibrillation (AF) prevalences have risen globally due to the increasing aging populations posing significant health challenges. Frailty, a state characterized by weak physiological reserves, has emerged as a crucial factor influencing cardiovascular disease outcomes, including those in patients with AF. With this systematic review and meta-analysis, we aimed to elucidate the impact of frailty on mortality, and the incidences of stroke, major bleeding events, and other outcomes in elderly patients with AF. Method: A comprehensive search of PubMed, EMBASE, and Scopus databases yielded 1302 relevant records from inception until January 2024. We screened them to assess their eligibility for our study. We included data from 23 studies into our analysis, covering a diverse global population. We also assessed the quality of the included studies by assigning Newcastle- Ottawa Scale scores. Results: Frailty demonstrated a consistent association with increased all-cause mortality (Hazards ratio [HR] 2.46 in frail individuals). Frailty also correlated with elevated risks of stroke (HR, 1.46) and major bleeding events (HR, 1.34). Our analysis also revealed non-significant associations with cardiovascular death and intra-cranial hemorrhage. Conclusion: Frailty significantly increases the frequency of adverse outcomes in elderly patients with AF; thus, these patients should be managed with tailored risk stratification tools. Integrating frailty assessments into clinical decision-making should aid in optimizing care strategies and enhance outcomes in this vulnerable population.