Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

[Collective outbreaks of foodborne infections and intoxications in Poland in 1985-1999]

In outbreaks of foodborne infections and intoxications in 1985-1999 in Poland among salmonellas S. Enteritidis amounted for 84.9% in 1986 and 97.8% in 1991-1992. In 1985-1999, among the total number of diseases in outbreaks most of the cases occurred after eating of the dishes made from eggs (over 50%). In 1987-1999, food prepared in private homes had the largest influence on the occurrence of the outbreaks (up to 65.4% of outbreaks). The private homes were also the most frequent places of the consumption of that food. Contamination of the ready-made dishes was found to be due to the raw materials, mainly eggs coming from private farms. In Poland and in neighboring countries Salmonella of animal's source determines the epidemiological situation of foodborne infections and intoxications.

[Outbreak of foodborne and waterborne infections and intoxications in hospitals and sanatoria in Poland in 1985-1999]

Fraction of the outbreaks of foodborne intoxications and infections in hospitals and sanatoria is estimated at 1.5% to 6.3% of the total number of outbreaks annually in 1985-1999. Number of people affected in hospitals/sanatoria constituted 2.7%-9.2% of the total number of cases in outbreaks. In the paper analyzes of number of cases in hospitals and sanatoria is shown, according to the food--vehicle of the foodborne intoxications and infections and according to the etiological agent. Eleven great epidemics (above 100 cases) in hospitals and seven in sanatoria were described in 1985-1999.

[Botulism in Poland in 1999]

Total 97 cases of botulism were registered in 1999 in Poland with incidence 0.25/100,000. In the rural area were registered 61 (incidence 0.41/100,000), and in the urban regions 36 (incidence 0.15) cases. The incidence among men (0.32) outnumbered the incidence among women (0.18). In 1999 there were 68 outbreaks of one person noted, 6 outbreaks of two people, 3 of three people and 2 of four people. Dishes from meat were the main vehicle of the botulinum toxin (58 cases; 59.8%). In this number prevailed home made conserves (wecks) from pork meat (26.8%). No deaths were registered in 1999.

[Intoxications caused by plant protection chemicals in 1998]

In 1998 were registered 118 cases of intoxications caused by chemicals used for plant protection. The most of intoxications occurred after the intake of pesticides (66.9%). Intended intake (suicidal) made 38 cases (32.2%) and accidental intake made 37 cases (31.4%). During the agricultural labour it came to exposure in 35 cases (29.7%). Insecticides caused 66.9% of the total number of cases. In rural regions 85.6% of the sick people were submitted to intoxication by pesticides and 14.4% in the urban regions. The morbidity of the men was more than three times higher than morbidity of the women (respectively 0.48 and 0.14). In 1998 three of two people outbreaks of intoxication by pesticides were noted. Because of intoxication by chemicals for plant protection 14 people died.

[Botulism in 1998]

Total 93 cases of botulism were registered in Poland in 1998. The morbidity amounted 0.24/100,000. In the rural regions were registered 61 (morbidity 0.41), and in the urban regions 32 (morbidity 0.13) cases. The morbidity of men (0.34) outnumbered the morbidity of women (0.15). In 1998 there were 57 outbreaks of one person noted, 8 outbreaks of two people, 4 of three people and 2 of four people. Among the vehicles of the botulinum toxin dishes from meat remained on the first position (50.5% of the cases) and in these numbers prevailed weeks of home production (18.3%). In 1998 were noted 4 deaths from botulism. In this number were 4 men (46, 57, 74 and 78 years old).

[Foodborne infections and intoxications in 1998]

In total were registered 30,515 cases of bacterial foodborne infections and intoxications (salmonelloses of animal source, staphylococcal, botulism, other bacterial and caused by undetermined agents) in 1998. Morbidity amounted 78.9/100,000. In 399 outbreaks of collective illnesses (4 people and more) 8225 cases were registered altogether. S. Enteritidis caused 92.5% cases in outbreaks. The main vehicle of foodborne infections and intoxications in outbreaks was food prepared from raw materials of animal source, which caused 86.8% cases in outbreaks. Dishes from eggs brought about 45.5% of these cases. Among the places of the ready made food production, private homes prevailed (58.1% of the whole amount of outbreaks). Seven epidemics numbering above 100 cases each were registered in 1998.

[Poisonings caused by plant protection chemicals in Poland in 1999]

Total number 121 cases of intoxications caused by the chemicals used for plant protection were registered in 1999 in Poland (morbidity 0.31/100,000). The most of intoxications (69.4%) occurred after intake of pesticides. In 43 cases (35.5%) it was intended (suicidal) intake. Accidental intake was in 35 cases (29.9%). In 27 cases (22.3%) exposure took place at agricultural labour. Insecticides caused 66.1% of the total number of cases. 81.0% of the sick people were subject of intoxication by pesticides in rural regions and 19.0% in the urban regions. The incidence of men was 2.8 times higher than incidence of women (respectively 0.47 and 0.17). In 1999 no group intoxications by pesticides were noted. As the result of intoxication by chemicals for plant protection 15 people died.

[Foodborne infections and poisonings in Poland in 1999]

The total number of 27,103 cases of bacterial foodborne infections and intoxications were registered in 1999. The incidence was 70.1/100,000. 6,269 cases were registered in 336 outbreaks of collective illnesses (4 people and more). S. Enteritidis was found in 97.1% of cases in outbreaks caused by Salmonella spp. The main vehicle of foodborne infections and intoxications in outbreaks was food prepared from eggs (52.5% cases in outbreaks). Private homes prevailed (58.3% of outbreaks) among the places of the ready made food production. Five epidemics with more than 100 cases each were registered in 1999.

[Foodborne infections and food poisoning in 1997]

In total were registered 27,922 cases of foodborne infections and intoxications in 1997 (salmonelloses of animal source, staphylococcal, botulism, other bacterial and caused by undetermined agents). Morbidity amounted 72.7/100,000. In 274 outbreaks of collective illnesses (4 people and more) 4,817 cases were registered altogether. Salmonella enteritidis caused 95.5% causes in outbreaks. The main vehicle of foodborne infections and intoxications in outbreaks was food prepared from raw materials of animal source, which caused 91.2% cases in outbreaks, in which dishes from eggs brought about 47.4% of these cases. Among the places of the ready made food production, private homes prevailed (57.9% of the whole amount of outbreaks). There epidemics numbering above 100 cases each were registered in 1997.

[Intoxications caused by plant protection chemicals in 1997]

In 1997 were registered 140 cases of intoxications caused by chemicals used for plant protection. The most of the intoxications occurred after the intake of pesticides (70.7% of diseases). Accidental intake made 36.4% of the total number of cases, and intended intake was 34.3%. During the agricultural labour it came to exposure in 28.6% of cases. Insecticides caused 68.6% of the total number of intoxications by pesticides. In rural regions 79.3% of the sick people were submitted to intoxication and 20.7% in the urban regions. The morbidity of men was almost three times higher than morbidity of women (respectively 0.54 and 0.20). In 1997 three outbreaks of intoxication by pesticides were noted: two of three people and one of two people. Because of intoxication by chemicals for plant protection 10 people died.

Surveillance of foodborne botulism in Poland: 1960-1998

Human foodborne botulism, in contrast to the other two forms of botulism (wound and infant botulism), is an intoxication that results when preformed botulinum toxin is ingested. Sporadic cases and family and general outbreaks occur when food products are

[Registration of the foodborne diseases in Poland in 1919-1997]

The aim of this paper was presenting of the history of registration of the foodborne and waterborne diseases in Poland, as well as describing of the epidemiological situation of these diseases. In the years between the I and II World Wars and from 1945 to 1947 enteric fever and bacterial dysentery were most often registered. From 1951 began the increasing of the total numbers of cases of the viral hepatitis with the peak of diseases in 1964 (about 125,000 cases). The years 80s were characterized by the increasing number of cases caused by Salmonella of animal's source with the peak in 1988 (about 62,000 cases). In the years 90s the decrease of the number of salmonelloses of animal's source occurred.

[Outbreaks of foodborne diseases of bacterial etiology in Poland in 1990-1996]

The domination of salmonellas of animal's source remains in Poland in 1990-1996 in outbreaks (from 84.4% to 95.8%), despite the decreasing of the yearly numbers of diseases caused by foodborne and waterborne infections and intoxications. Participation of the S. enteritidis among salmonellas of animal's source amounted from 92.6% to 97.8%. The most cases in the total number of diseases in outbreaks occurred after eating of the dishes made from eggs (from 41.8% to 54.9%). Food prepared in private homes contributed to the occurrence of the outbreaks to the highest degree (from 61.1% to 74.3%). The private homes were also the most frequent places of the consumption of those dishes. It results from the epidemiological data that raw materials (mainly eggs) coming from private farms contributed to the contamination of ready food to a high degree.

[Botulism in 1997]

In 1997 81 cases of botulism in Poland were registered. The morbidity amounted 0.21/100,000. In the rural regions were registered 55, and in urban regions 26 cases. The morbidity in the rural regions amounted 0.37, and in urban regions 0.13. The morbidity of men (0.23) outnumbered the morbidity of women (0.19). In 1997 there were 8 outbreaks of two people noted, 2 outbreaks of three people and 2 of four people. Among the vehicles of the botulinum toxin dishes from meat remained on the first position (65.4% of cases), and in these numbers prevailed wecks of home production (19.8%). No deaths caused by botulinum toxin were noted in 1997.