P1374Atrial fibrillation and physical function decline in an Italian elderly population: the InCHIANTI Study experience

Abstract

Background: Atrial fibrillation (AF) is the most frequent sustained arrhythmia diagnosed in elderly patients. Its prevalence can be as high as 85 per 1,000 people >65 years. AF is associated with increased risk of heart failure, stroke and dementia. Previous clinical data suggest that the arrhythmia may be considered a marker of frailty. Thus, we hypothesized that older persons with AF are more likely to experience accelerated functional decline compared to those without the arrhythmia. Methods: We used data from participants aged ≥70 years enrolled in the InCHIANTI Study, a longitudinal study of community dwelling older persons living in the surroundings of Florence (Italy). Participants were assessed at baseline (BL) in 1998, and at periodical follow-up (FU) evaluations (the 5th visit will be completed between 2016 and 2017). For the present study, we analysed BL characteristics, and FU-1 and FU- 2 data, collected at 3 and 6 years, respectively. The diagnosis of AF was established from EKG recordings. Physical function was evaluated by the Short Physical Performance Battery (SPPB), a tool exploring balance, gait speed, strength and endurance that produces a score ranging from 0 to 12 (lowest to highest performance). The SPPB is a strong predictor of mortality and disability. Multilevel models (STATA/SE 12.0) were utilized to analyse the association between AF and SPPB in the three study periods. Results: At BL, the prevalence of AF was 4.9% (N=34/694). Subjects with the arrhythmia were older (81±6 vs. 77±6 years, p<0.01), with no difference in gender and in physical function (SPPB - AF: 11.0±1.7 vs. No AF: 10.7±2.0, p>0.10). After 6 years, SPPB was 7.8±3.8 and 9.3±2.8 in AF and No-AF subjects, respectively. Multivariate analysis showed that the baseline presence of the arrhythmia was significantly associated with accelerated physical function decline (score difference between AF and No-AF subjects: 1.4±0.5, p=0.007), independently of age, sex, neurocognitive profile, body mass index, muscle strength, creatinine, depressive symptoms and smoking. Time trends of physical function between AF and No-AF populations diverged after the three years evaluation. Conclusions: In elderly subjects living in community, the presence of AF is significantly and independently associated with accelerated physical performance decline over time. Whether a rhythm-control strategy may prevent physical function decline should be established in future studies.