Frailty Syndrome: An Emerging Clinical Problem in the Everyday Management of Clinical Arrhythmias

The Results of the European Heart Rhythm Association Survey

Stefano Fumagalli; Tatjana S. Potpara; Torben Bjerregaard Larsen; Kristina H. Haugaa; Dan Dobreanu; Alessandro Proclemer; Nikolaos Dagres


Europace. 2017;19(11):1896-1902. 

In This Article

Abstract and Introduction


The age of patients presenting with complex arrhythmias is increasing. Frailty is a multifaceted syndrome characterized by an increased vulnerability to stressors and a decreased ability to maintain homeostasis. The prevalence of frailty is associated with age. The aims of this European Heart Rhythm Association (EHRA) EP Wire survey were to evaluate the proportion of patients with frailty and its influence on the clinical management of arrhythmias. A total of 41 centres—members of the EHRA Electrophysiology Research Network—in 14 European countries completed the web-based questionnaire in June 2017. Patients over 70 years represented 53% of the total treated population, with the proportion of frail elderly individuals reaching approximately 10%; 91.7% of the responding centres reported treating frail subjects in the previous year. The respondents usually recognized frailty based on the presence of problems of mobility, nutrition, and cognition and inappropriate loss of body weight and muscle mass. Renal failure, dementia, disability, atrial fibrillation, heart failure, falls, and cancer were reported to characterize the elderly frail individuals. Atrial fibrillation was considered the prevalent arrhythmia associated with frailty by 72% of the responding centres, and for stroke prevention, non-vitamin K antagonist oral anticoagulants were preferred. None of the respondents considered withholding the prevention of thrombo-embolic events in subjects with a history of falls. All participants have agreed that cardiac resynchronization therapy exerts positive effects including improvement in cardiac, physical, and cognitive performance and quality of life. The majority of respondents preferred an Arrhythmia Team to manage this special population of elderly patients, and many would like having a simple tool to quickly assess the presence of frailty to guide their decisions, particularly on the use of complex cardiac implantable electrical devices (CIEDs). In conclusion, the complex clinical condition in frail patients presenting with arrhythmias warrants an integrated multidisciplinary approach both for the management of rhythm disturbances and for the decision on using CIEDs.


The aging process of population and improvements in medical therapy have accounted for the progressive increase of elderly patients presenting with a clinically relevant arrhythmia. Aging is frequently characterized by the coexistence of several comorbid conditions, often reciprocally interacting to produce a greater than additive negative impact on health status. At the same time, sub-clinical malnutrition, inactivity, and low-grade inflammation may exert a hidden effect on several body systems. All these changes are associated with frailty development, an age-related phenomenon, characterized by an increased vulnerability to stressors and a decreased ability to maintain homeostasis.[1]

The aims of this European Heart Rhythm Association (EHRA) EP Wire survey were to evaluate, among European electrophysiology (EP) centres, the prevalence of frailty in everyday clinical practice and to assess its influence on medical conduct when coping with arrhythmia management.