AIMS: Frailty is common in patients with atrial fibrillation (AF), with possible impact on therapies and outcomes. However, definitions of frailty are variable, and may not overlap with frailty perception among physicians. We evaluated the prevalence of frailty as perceived by enrolling physicians in the Edoxaban Treatment in Routine Clinical Practice for Patients With Non-Valvular AF (ETNA-AF)-Europe registry (NCT02944019), and compared it with an objective frailty assessment. METHODS AND RESULTS: ETNA-AF-Europe is a prospective, multi-centre, post-authorization, observational study. There we assessed the presence of frailty according to (i) a binary subjective investigators' judgement and (ii) an objective measure, the Modified Frailty Index. Baseline data on frailty were available in 13 621/13 980 patients. Prevalence of perceived frailty was 10.6%, with high variability among participating countries and healthcare settings (range 5.9-19.6%). Conversely, only 5.0% of patients had objective frailty, with minimal variability (range 4.5-6.7%); and only <1% of patients were identified as frail by both approaches. Compared with non-frailty-perceived, perceived frail patients were older, more frequently female, and with lower body weight; conversely, objectively frail patients had more comorbidities. Non-recommended edoxaban dose regimens were more frequently prescribed in both frail patient categories. CONCLUSIONS: Physicians' perception of frailty in AF patients is variable, mainly driven by age, sex, and weight, and quite different compared with the results of an objective frailty assessment. Whatever the approach, frailty appears to be associated with non-recommended anticoagulant dosages. Whether this apparent inappropriateness influences hard outcomes remains to be assessed.

Cardiology Department 'G Pasquinucci' Heart Hospital 'G Monasterio' Foundation Massa Italy

Cardiology Department Barnet General Hospital Thames House Enfield UK

Daiichi Sankyo Europe GmbH 81379 Munich Germany

Department of Experimental and Clinical Medicine University of Florence Florence Italy; and AOU Careggi Florence Italy

Department of Experimental Diagnostic and Specialty Medicine Institute of Cardiology University of Bologna Policlinico S Orsola Malpighi 40138 Bologna Italy

Department of Immunochemistry Diagnostics Faculty of Medicine in Pilsen of Charles University Pilsen Czech Republic

Department of Surgical Medical and Molecular Pathology and of Critical Sciences University of Pisa Pisa Italy

Division of Cardiology Azienda Ospedaliero Universitaria Pisana via Paradisa 2 56124 Pisa Italy

Fondazione VillaSerena per la Ricerca Città Sant'Angelo Pescara Pescara Italy

German Center for Cardiovascular REserach partner site Hamburg Kiel Lübeck Germany

Institute of Cardiovascular Sciences University of Birmingham Birmingham UK

Royal Free Hospital London NHS Foundation Trust London UK

University Heart and Vascular Center Hamburg University Medical Center Hamburg Eppendorf Hamburg Germany

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