Frailty in older patients with atrial fibrillation in Vietnam: a comparison between the physical frailty phenotype and the Clinical Frailty Scale

Background . There is limited evidence on the prevalence of frailty and its impact on health outcomes in older adults with atrial fibrillation (AF) in Vietnam. This study aimed to (1) Examine the prevalence of frailty in older hospitalised patients with AF, using the frailty phenotype (Fried’s criteria) and the Clinical Frailty Scale (CFS), and (2) Compare the associations of these frailty definitions with hospitalisation. Methods . Adults aged 65 or older with AF attending the outpatient clinics of Thong Nhat Hospital, Ho Chi Minh City, Vietnam, from December 2022 to September 2023 were included in this study. Frailty was defined as having ≥3/5 of Fried’s criteria or a CFS≥4. All participants were followed up for 9 months, recording hospitalizations. Results . There were 305 participants. They had a mean age of 76.7 (SD 7.8), 40% were female. The prevalence of frailty was 34% according to Fried’s criteria, and 88% according to the CFS (Kappa coefficient 0.14, 95%CI 0.09–0.19). The hospitalisation rate during follow up was 28.8%, higher in frail participants compared to the non-frail. The sensitivity and specificity for predicting hospitalisation were 95.3% and 15.0% for CFS≥4, and 44.2% and 69.5% for Fried’s criteria, respectively. Frailty defined as CFS≥4 was significantly associated with increased hospitalisation (adjusted OR 3.72, 95%CI 1.23–11.31, p=0.020). A weaker association was observed with frailty defined by Fried’s criteria (adjusted OR 1.64, 95%CI 0.95–2.84, p=0.077). Similar results were obtained when frailty was analysed as a continuous score: adjusted ORs 1.39 (95%CI 1.05–1.83, p=0.022) for each higher number of CFS categories, and 1.24 (95%CI 1.00 – 1.53, p=0.051) for each unit higher Fried’s score. Conclusion . Frailty was highly prevalent among older patients with AF. There was a poor correlation between the two frailty criteria when identifying frail and non-frail participants in the cohort using the cut-offs. Despite this, both measures of frailty worked well as predictors of hospitalisation, and using the suggested cutoff of CFS≥4 is more likely to accurately identify future hospitalisations. Further studies are needed to compare the predictive values of these two frailty definitions in older adults in Vietnam.