(P264) THE RELATIONSHIP BETWEEN FRAILTY AND POSTOPERATIVE ATRIAL FIBRILLATION IN PATIENTS UNDERGOING CARDIAC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Postoperative atrial fibrillation (POAF) occurs in roughly one third of patients who have undergone cardiac surgery, resulting in increased mortality, morbidity, and costs to the healthcare system. Frailty, a clinical syndrome of physiological decline, is highly associated with increased risk of poor outcomes after cardiac surgery. Whether frailty is associated with POAF rates has not been established.

METHODS AND RESULTS: We systematically searched MEDLINE and Embase from inception to January 2024 for studies reporting preoperative frailty scores and rates of POAF following cardiac surgery. Studies reporting frailty in patients undergoing transcatheter aortic valve replacement were assessed for POAF rates separately. Pooled risk ratios (RR) and 95% confidence intervals (CI) were estimated for frail vs. non-frail patients using a random-effect model.

Sixteen studies involving 6,662 patients who underwent coronary artery bypass, surgical valve replacement, or a combination were identified. These studies used a variety of frailty assessments with the prevalence of frailty ranging from 7.7% to 76.7%. Meta-analysis indicated that frailty was associated with higher risk of POAF following cardiac surgery (RR 1.23; 95% CI 1.11-1.36, P=0.0001). Subgroup analysis assessing patient age, study design, surgery type, and sample size, showed consistent effects of frailty on POAF. Interestingly, subgroup analysis found that risk of POAF was higher in studies that assessed frailty by clinical scales (RR 1.30; 95% CI 1.14-1.48, P< 0.0001) compared to those that assessed frailty by surrogate imaging/lab-based modalities (RR 1.10; 95% CI 0.94-1.30, P=0.24). In contrast to cardiac surgery, meta-analysis of 3 studies on patients (n=1,279) who underwent TAVR showed no association between frailty and POAF (RR 1.24; 95% CI 0.81-1.88, P=0.32).

Conclusion: Overall, this meta-analysis highlights the strong link between frailty and increased POAF risk in patients undergoing cardiac surgery. Despite the limitations associated with varied frailty assessment methods among studies, clinically evaluated frailty showed a stronger association with POAF compared to surrogate markers. This underscores the importance of comprehensive clinical frailty assessments in preoperative evaluations to identify high-risk patients and tailor perioperative management strategies accordingly.