Atrial fibrillation is a possible marker of frailty in hospitalized patients: results of the GIFA Study

Background and aims: Atrial fibrillation (AF) is the most common arrhythmia in elderly people, who are particularly exposed to its most severe complications, such as stroke, worsening heart failure and dementia. Some studies demonstrate that AF is associated with increased mortality in home-dwelling subjects, but little is known about the clinical impact of the arrhythmia in hospitalized patients. We studied the clinical associations and effects of AF on the 23,174 hospitalized patients enrolled in the GIFA (Gruppo Italiano di Farmacoepidemiologia nell''Anziano) Study. Methods: Patients were divided into three groups according to the absence or presence of AF (sinus rhythm, non-AF; AF as main diagnosis, AF-main; AF as comorbid condition, AF-associated) and stratified into four age-groups (≤60, 61-70, 71-80 and >80 yrs). Results: AF-associated patients were older, more frequently disabled, and characterized by greater comorbidity and longer in-hospital length of stay. Urea nitrogen concentration was higher, and total cholesterol was lower in AF-associated patients, compared with the other two groups. Overall mortality was 6.0%. Mortality was higher in AF-associated patients (non-AF: 6.0% vs AF-associated: 7.1% vs AF-main: 0%, p<0.001). Conclusions: Our results suggest that, in hospitalized patients, AF as a comorbid condition is associated with worse metabolic profile and clinical outcomes, and thus, may represent a marker of frailty.