Mobility impairment in European patients with atrial fibrillation: results from a prospective multinational European registry
M Proietti, G F Romiti, B Corica, D Mei, G Boriani, G Y H LipAbstract
Introduction
Atrial fibrillation (AF) is common in older adults and can be considered as part of a clinical geriatric syndrome model. Similarly, mobility impairment is associated with lower quality of life, higher healthcare expenditures, and a greater risk of adverse outcomes. Nonetheless, little data exist regarding the impact of mobility impairment in patients with AF.
Methods
Data for the present analysis were derived from a European observational study enrolling AF patients across 250 centres in 27 European countries from 2013 to 2016. Data on mobility impairment were derived from the mobility item in the EQ-5D-5L questionnaire, collected at baseline. Complete clinical and pharmacological data were collected at baseline. The primary outcome was a composite of all-cause death and major adverse cardiovascular events.
Results
Among the original 11,096 patients enrolled, data on 8,954 (80.7%) were available for this analysis (median [IQR] age 71 [62-77] years; 39.8% female). Of these, 3,686 (41.2%) presented with mild/moderate mobility impairment, while 775 (8.7%) had severe mobility impairment or were unable to walk. Patients with increasing mobility impairment were progressively older, more likely female, and overweight/ obese. Both baseline thromboembolic and bleeding risk were increasingly higher with increasing severity of mobility impairment (Table). At baseline, when compared to patients with no impairment or mild/moderate mobility impairment, those with more severe mobility impairment/unable to walk had greater multimorbidity (70.3% vs 86.5% vs 90.3%, respectively), frailty (9.1% vs 29.9% vs 51.8%), and polypharmacy (43.2% vs 61.5% vs 69.7%) (all p<0.001). After adjustments, when compared with no impairment, the mild/moderate mobility impairment and severe mobility impairment/unable to walk groups had a lower likelihood of oral anticoagulant prescription (ORs 0.75, 95% CI 0.65-0.86, and 0.55, 95% CI 0.44-0.69, respectively). During follow-up, there was an increasing cumulative incidence of the primary composite outcome across the three groups [Figure]. After full adjustments, compared with no impairment, mild/moderate mobility impairment and severe mobility impairment/unable to walk groups were associated with an increased risk of the composite outcome (HRs 1.93, 95% CI 1.67-2.23, and 2.86, 95% CI 2.36-3.46, respectively).
Conclusions
Mobility impairment affects a substantial proportion of AF patients, and influences both clinical management and clinical course, with a progressively higher risk of adverse outcomes as the severity of mobility impairment increases.Table:Clinical CharacteristicsFigure:Primary Outcome Cumulative Incidence