Frailty and advanced age in atrial fibrillation: Implications for treatment strategies and clinical outcomes - A systematic review.

BACKGROUND

Atrial fibrillation (AF) is common among frail older adults and poses complex management challenges due to reduced physiological reserve and heightened vulnerability to adverse outcomes.

AIMS: This systematic review (2015-2025) examined influence of frailty and advanced age on AF management and outcomes, focusing on anticoagulation, interventional therapies and quality of life.

METHODS

Eligible cohort studies, trials, meta-analyses assessed outcomes including mortality, stroke, major bleeding, functional decline, recurrence, healthcare costs and quality of life with frailty measured using validated tools like Clinical Frailty Scale.

RESULTS

Frail patients had a two-to threefold higher mortality risk and 40-50% greater incidence of stroke and major bleeding than non-frail peers. Low-dose NOACs reduced stroke in frail octogenarians but bleeding risk persisted. Rate control therapy improved symptoms yet increased hypotension risk. Catheter ablation showed lower success and more complications.

CONCLUSIONS

Severe frailty and age ≥85 were associated with poorer outcomes, higher resourcutilization and reduced quality of life.