The effect of presence of atrial fibrillation on frailty in heart failure patients with reduced ejection fraction

The Effect of Presence of Atrial Fibrillation on Frailty in Heart Failure Patients with Reduced Ejection Fraction The aim of this study is to examine the effect of the presence of atrial fibrillation (AF) on frailty parameters in Patients with Heart Failure with Reduced Ejection Fraction (HFrEF). 45 patients with HFrEF and sinus rhythm (SR) and atrial 44 patients with HFrEF with fibrillation (AF) were recruited. Gait speed in frailty assessment, 6 MWT, TUG test, handgrip Strength test, PRISMA-7 questionnaire, and Minnesota heart failure with heart failure questionnaire were used. Diabetes mellitus, hypertension and chronic kidney disease rates were found to be similar in both groups. Ischemic etiology was significantly higher in the SR group, and was significantly higher in the group with heart valve prosthesis AF. NT-proBNP value was statistically significantly higher in the AF group. Albumin and total protein values were statistically significantly lower in the AF group. Left atrial diameter, left atrial volume index, tricuspid regurgitation velocity, systolic pulmonary artery pressure, right atrium area, inferior vena cava diameter were statistically significantly higher in the AF group. Tricuspid annular plane systolic excursion (TAPSE) and tricuspid S velocity were significantly lower in the AF group. 6- minute walk test (MWT) and handgrip strength test for frailty assessment was significantly lower in the AF group. Time up and go test (TUG Test) was significantly higher in the AF group. No significant difference was found between AF and SR patient groups in the walking speed test, PRISMA-7 questionnaire, Minnesota living with heart failure questionnaire. Using the Charlson comorbidity index, we created a new frailty index from parameters with different weights. As a result of the cluster analysis, the patients were divided into 4 groups according to the severity of frailty. In multinomial logistic regression analysis, GFR, NT-proBNP, albumin, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial volume index, lateral e' wave, septal e' wave, tricuspid regurgitation 8 velocity, systolic pulmonary artery pressure, tricuspid annular plane systolic excursion, tricuspid S wave velocity, and inferior vena cava diameter were determined as independent predictors of frailty. It was found that AF in HFrEF patients increased the risk of moderate frailty by 3.4 times, and the risk of severe frailty by 5.5 times, and high NT-proBNP caused a 2 times increase in the risk of severe frailty. It was found that low GFR causes a 2 times increase in the risk of severe frailty, and low albumin causes a 4.2 times increase in the risk of severe frailty. High left ventricular end-diastolic diameter causes a 4.6 times increase in the risk of severe frailty, a high left ventricular end-systolic diameter causes a 4.9 times increase in the risk of severe frailty, and a high left atrial volume index causes an 11.3 times increase in the risk of severe frailty. found. An increase in tricuspid regurgitation velocity causes a 6.5 times increase in the risk of severe frailty, high systolic pulmonary artery pressure and a high inferior vena cava diameter cause a 2.1 times increase in the risk of severe frailty. It was found that low tricuspid annular plane systolic excursion increased the risk of severe frailty by 2.3 times. In conclusion, the presence of AF was found to be an independent predictor of frailty in patients with HFrEF. Keywords: Heart failure with reduced ejection fraction, Atrial fibrillation, Frailty, Frailty parameters, Frailty index