Atrial Fibrillation Doesn’t Come Alone: The Geriatric Syndromes Behind the Arrhythmia

is associated with significant morbidity and mortality in older adults, including increased risk of ischemic stroke, heart failure, functional decline, and diminished quality of life (3,5).The management of AF in older adults is particularly challenging due to the high prevalence of multimorbidity, polypharmacy, and a constellation of age-related vulnerabilities collectively known as geriatric syndromes.Geriatric syndromes are multifactorial clinical conditions not attributable to discrete diseases but resulting from cumulative deficits in multiple organ systems.Epidemiological studies reveal that over 90% of communitydwelling older adults have at least one geriatric syndrome, and approximately 70-75% have two or more concurrent geriatric AbstractObjective: Atrial fibrillation (AF) is a frequent arrhythmia in older adults; geriatric syndromes, which are prevalent in this population, may influence AF outcomes.This study aimed to uncover the independent associations between AF and key geriatric syndromes in a real-world outpatient population. Materials and Methods:This retrospective cross-sectional study examined patients aged 65 years or older who underwent comprehensive geriatric assessment at a tertiary-care outpatient clinic between 2012 and 2024.Univariate and multivariate analyses were performed to examine the associations between AF and geriatric syndromes.Results: In 1251 patients the mean age was 75.7 ± 6.8 years, and 68.5% were female.AF prevalence was 11.5% (n = 145).Patients with AF (those whohad a current diagnosis of AF or in whom AF was newly detected during routine annual ECG screening) were older (mean age 77.9 ± 7.4 years) andwere predominantly female (73.1%).AF was significantly more prevalent in patients with frailty (p < 0.001), polypharmacy (defined as ≥5 drugs;p < 0.001), and constipation (p = 0.039).In multivariate analysis, advanced age [odds ratio (OR): 1.041, 95% confidence interval (CI): 1.011-1.072;p = 0.007], frailty (OR: 2.029, 95% CI: 1.337-3.080;p < 0.001), and polypharmacy (OR: 2.961, 95% CI: 1.789-4.900;p < 0.001) were independently associated with AF.Conclusion: AF in older adults is not an isolated cardiac event but an indicator of broader geriatric vulnerability.Our findings indicate important associations between frailty, polypharmacy, and AF.These results underscore the critical need to shift from rhythm-focused care to a holistic, geriatriccentered approach in managing older adults with AF.