If you treat patients, no trial at ESC is more important, according to John Mandrola, MD. The results of FRAIL-AF demonstrate the value of humility in science and the practice of evidence-based medicine.
One of the hardest tasks of a clinician is applying evidence from trials to the person in your office. At the European Society of Cardiology congress, the surprising and unexpected results of theFRAIL-AF investigators set out to study the question of whether frail, elderly patients withwho were doing well with vitamin K antagonists should be switched to direct-acting oral anticoagulants .
included few elderly patients with frailty. Second, first author Linda Joosten, MD, made it clear in her presentation that frailty is a lot more than aging. It is a clinical syndrome, which entails a"high burden of comorbidities, dependency on others, and a reduced ability to resist stressors.
The primary endpoint was major or clinically relevant nonmajor bleeding, whichever came first, accounting for death as a competing risk. Follow-up was 1 year.Joosten started her presentation with this:"The results turned out to be different than we expected." The authors designed the trial with the idea that switching to DOACs would be superior in safety to remaining on VKAs.
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