Atrial Fibrilasyonun Geriatrik Yaş Grubunda Genel Özellikleri, Fonksiyonellik ve Frailite ile İlişkisi
Özet
Atrial fibrillation (AF) is the most common cardiac arrhythmia in geriatric age group and it causes significant complications such as ischemic stroke, heart failure, dementia, and decreased quality of life. The frequency of AF and its complications increase with age. Frailty is a geriatric syndrome characterized by reduced homeostatic reserves of the organism that causes increased vulnerability to various stressors and assocciated with increased risk of poor clinical outcomes including falls, disability, need for long-term care, and mortality. The hypothesis that AF may result in increased frailty is based on their common pathogenesis and the association of AF with other conditions which may lead to frailty. AF is associated with development of dementia, impairment in quality of life, cerebrovascular events, and heart failure. In this study, it was aimed to investigate the general clinical features of AF in geriatric age group and its relationship with frailty. For this purpose, a total of 123 patients aged 65 years and over of whom 64 with AF and 59 with normal sinus rhythm were enrolled in the study between January 1, 2017 and June 30, 2017 at the Hacettepe University Hospital Geriatric Medicine outpatient clinic. All patients underwent routine medical history, physical examination, and comprehensive geriatric assessment. Frailty status was assessed using the Fried criteria and also FRAIL scale. The brief Older People's Quality of Life (OP-QoL-brief) questionnaire was applied to measure the quality of life. Results of routine laboratory tests were recorded. Patients’ data were evaluated and compared for AF and control groups. The mean age of the AF group was higher than the control group (p=0.002). Demographic characteristics other than age and education level were similar for the two groups. The number of chronic diseases and the number of drugs used in the AF group were found to be higher when compared to the control group (p <0.001 for both). Comprehensive geriatric assessment revealed lower Lawton-Brody IADL (Instrumental Activities of Daily Living) scores (p=0.024), higher fall rates in previous year (p = 0.016) and slower walking speed (p=0.020) in the AF group. Although the frequency of frailty status determined by the Fried criteria or the FRAIL scale was higher in the AF group, this was not statistically significant. However it was found that there was a statistically significant positive relationship between the EHRA AF symptom score and the robust-prefrail-frail status according to the FRAIL scale (Goodman ve Kruskal Gamma coefficient= 0.39 and p=0.020). There was no significant difference between the two groups in terms of quality of life that is determined by OP-QoL-brief. The comparison of the results of laboratory tests for two groups revealed total cholesterol, LDL, HDL, total protein, albumin, and prealbumin were lower, BNP, and CRP levels were higher in AF group. Results of the examination of the clinical characteristics of AF in the geriatric age group revealed that the mean age was 75.31 ± 5.67. Long standing persistent was the most common clinical AF type which was seen in 70.3% of the patients. 64.1% of the patients were found to be symptomatic. The risk of ischemic stroke was assessed by the CHA2DS2VASc score and all patients were found to be at high risk. The HAS-BLED score was used to assess the bleeding risk under anticoagulation therapy and the rate of patients with a high risk of bleeding was 43.7%. As a result of this study, it was determined that AF is associated with walking speed and IADL, which are related to frailty, and EHRA AF symptom severity score is related with frailty. The presence of frailty and its components must be investigated in AF patients.