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Europace. 2017 Nov 1;19(11):1896-1902. doi: 10.1093/europace/eux288.

Frailty syndrome: an emerging clinical problem in the everyday management of clinical arrhythmias. The results of the European Heart Rhythm Association survey.

Author information

1
Geriatric Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
2
School of Medicine, Cardiology Clinic, Clinical Centre of Serbia, University of Belgrade, Visegradska 26, Belgrade 11000, Serbia.
3
Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital, Søndre Skovvej 15, DK-9100 Aalborg, Denmark.
4
Department of Cardiology, Institute for Surgical Research, Institute for Clinical Medicine, Center for Cardiological Innovation, Oslo University Hospital, University of Oslo, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway.
5
Cardiology Clinic, Emergency Institute for Cardiovascular Diseases and Transplant, University of Medicine and Pharmacy, 540136 Tirgu Mures, Romania.
6
Cardiology Division, University Hospital S. Maria della Misericordia, P.le Santa Maria della Misericordia 15, 33100 Udine, Italy.
7
Department of Electrophysiology, Leipzig University - Heart Centre, 04289 Leipzig, Germany.

Abstract

The age of patients presenting with complex arrhythmias is increasing. Frailty is a multifaceted syndrome characterized by an increased vulnerability to stressors and a decreased ability to maintain homeostasis. The prevalence of frailty is associated with age. The aims of this European Heart Rhythm Association (EHRA) EP Wire survey were to evaluate the proportion of patients with frailty and its influence on the clinical management of arrhythmias. A total of 41 centres-members of the EHRA Electrophysiology Research Network-in 14 European countries completed the web-based questionnaire in June 2017. Patients over 70 years represented 53% of the total treated population, with the proportion of frail elderly individuals reaching approximately 10%; 91.7% of the responding centres reported treating frail subjects in the previous year. The respondents usually recognized frailty based on the presence of problems of mobility, nutrition, and cognition and inappropriate loss of body weight and muscle mass. Renal failure, dementia, disability, atrial fibrillation, heart failure, falls, and cancer were reported to characterize the elderly frail individuals. Atrial fibrillation was considered the prevalent arrhythmia associated with frailty by 72% of the responding centres, and for stroke prevention, non-vitamin K antagonist oral anticoagulants were preferred. None of the respondents considered withholding the prevention of thrombo-embolic events in subjects with a history of falls. All participants have agreed that cardiac resynchronization therapy exerts positive effects including improvement in cardiac, physical, and cognitive performance and quality of life. The majority of respondents preferred an Arrhythmia Team to manage this special population of elderly patients, and many would like having a simple tool to quickly assess the presence of frailty to guide their decisions, particularly on the use of complex cardiac implantable electrical devices (CIEDs). In conclusion, the complex clinical condition in frail patients presenting with arrhythmias warrants an integrated multidisciplinary approach both for the management of rhythm disturbances and for the decision on using CIEDs.

KEYWORDS:

Anticoagulants; Arrhythmia team; Atrial fibrillation; Cardiac implantable electrical devices; EHRA survey; EP wire; Elderly; Frailty

PMID:
29040554
DOI:
10.1093/europace/eux288
[Indexed for MEDLINE]

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