ESC 2023 — Dr Linda Joosten (Julius Center for Health Sciences and Primary Care, NL) joins us to discuss the findings of the FRAIL-AF trial.

FRAIL-AF is a multicentre, open-label randomised controlled clinical trial which studied frail elderly patients who receive vitamin K antagonist (VKA) treatment for atrial fibrillation (AF). Current clinical guidelines recommend non-vitamin K antagonists (NOACs) as opposed to VKAs for stroke prevention in patients with AF. Frail-elderly patients have previously been under-represented in landmark NOAC trials - this study aims to assess whether switching from international normalised radio (INR)-guided VKA management to a NOAC-based treatment strategy as compared to continued VKA-management is safe and effective in this population. 

Results showed higher bleeding complications in frail elderly patients with AF when switching from VKA treatment to NOACs when compared to continuing VKA treatment. The higher bleeding risk was not found to be offset by a lower risk of thromboembolic events. 

Questions:

1. What knowledge gap is this study trying to address?
2. Describe the differences between NOAC therapy as compared to VKA therapy/
3. What was the study design and patient population?
4. What are the key results?
5. What are your take-home messages?
6. What further research is still needed?

Recorded on-site at ESC Congress 2023, Amsterdam. 

Editors: Mirjam Boros and Jordan Rance
Video Specialists: Dan Brent, Tom Green, Mike Knight, Oliver Miles