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Vol. 219. Issue 8.
Pages 424-432 (November 2019)
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Vol. 219. Issue 8.
Pages 424-432 (November 2019)
Original article
DOI: 10.1016/j.rceng.2019.04.002
Sarcopenia, frailty, cognitive impairment and mortality in elderly patients with non-valvular atrial fibrillation
Sarcopenia, fragilidad, deterioro cognitivo y mortalidad en pacientes ancianos con fibrilación auricular no valvular
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M.A. Requena Callejaa, A. Arenas Miquéleza, J. Díez-Manglanoa,
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jdiez@aragon.es

Corresponding author.
, A. Gullónb, A. Posec, F. Formigad, J.M. Mostazae, J.M. Cepedaf, C. Suárezb, on behalf of the researchers of the NONAVASC study Vascular Risk Group of the Spanish Society of Internal Medicine 1
a Departamento de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
b Departamento de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain
c Departamento de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
d Departamento de Medicina Interna, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
e Departamento de Medicina Interna, Hospital Carlos III, Madrid, Spain
f Departamento de Medicina Interna, Hospital Vega Baja, Orihuela, Alicante, Spain
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Table 1. Baseline characteristics of the patients included in the study.
Table 2. Conditions associated with mortality at 1 year.
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Abstract
Objectives

To determine the prevalence of sarcopenia, frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation (NVAF) and the factors’ influence on survival.

Methods

Prospective, multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain. For each patient, we recorded the creatinine, hemoglobin and platelet levels, the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index, as well as the use of oral anticoagulants. We measured sarcopenia with the SARC-F scale, frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire. We also conducted a 1-year follow-up.

Results

The study included 596 patients with NVAF, with a mean age of 84.9 (SD: 5.2) years. Of these, 295 (49.5%) presented sarcopenia, 305 (51.2%) presented frailty, and 251 (42.1%) presented cognitive impairment. At the end of 1year, 226 (37.9%) patients had died. Mortality was greater for the patients with sarcopenia, frailty and cognitive impairment. In the multivariate analysis, sarcopenia (HR: 1.775; 95% CI: 1.270–2.481), age, comorbidity and a history of peripheral embolism were associated with increased mortality, and the use of oral anticoagulants at discharge (HR: 0.415; 95% CI: 0.307–0.560) was associated with lower mortality.

Conclusions

Sarcopenia, frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated. Sarcopenia was associated with increased mortality.

Keywords:
Atrial fibrillation
Sarcopenia
Frailty
Cognitive impairment
Mortality
Elderly
Cohort study
Resumen
Objetivos

Determinar la prevalencia de la sarcopenia, la fragilidad y el deterioro cognitivo en pacientes ancianos con fibrilación auricular no valvular (FANV) y su influencia en la supervivencia.

Métodos

Estudio de cohortes, prospectivo y multicéntrico realizado con pacientes >75años con FANV hospitalizados en servicios de Medicina Interna en España. Para cada paciente se recogieron los niveles de creatinina, hemoglobina y plaquetas, así como las escalas CHA2DS2-Vasc, HAS-BLED, el índice de Charlson y el uso de anticoagulantes orales. Se midió la sarcopenia con escala SARC-F, la fragilidad con la escala FRAIL y el deterioro cognitivo con el Short Portable Mental State Questionnaire. Se realizó seguimiento durante un año.

Resultados

Se incluyeron 596 pacientes con FANV, con edad media de 84,9 (DE: 5,2) años. De ellos, 295 (49,5%) presentaban sarcopenia, 305 (51,2%) fragilidad y 251 (42,1%) deterioro cognitivo. Al cabo de un año fallecieron 226 (37,9%) pacientes. La mortalidad fue superior en los pacientes con sarcopenia, fragilidad y deterioro cognitivo. En el análisis multivariante la sarcopenia (HR: 1,775; IC95%: 1,270-2,481), la edad, la comorbilidad y el antecedente de embolismo periférico se asociaron con mayor mortalidad, y el uso de anticoagulantes orales al alta (HR: 0,415; IC95%: 0,307-0,560), con menor mortalidad.

Conclusiones

En los pacientes ancianos con FANV la sarcopenia, la fragilidad y el deterioro cognitivo son muy prevalentes y se asocian con frecuencia. La sarcopenia se asocia a mayor mortalidad.

Palabras clave:
Fibrilación auricular
Sarcopenia
Fragilidad
Deterioro cognitivo
Mortalidad
Ancianos
Estudio de cohortes

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