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. 2022 May;19(5):814-821.
doi: 10.1016/j.hrthm.2022.01.007. Epub 2022 Jan 11.

Frailty in patients undergoing percutaneous left atrial appendage closure

Allen Wang  1 , Enrico G Ferro  1 , Yang Song  1 , Jiaman Xu  1 , Tianyu Sun  1 , Robert W Yeh  1 , Jordan B Strom  1 , Daniel B Kramer  2
Affiliations

Frailty in patients undergoing percutaneous left atrial appendage closure

Allen Wang et al. Heart Rhythm. 2022 May.

Abstract

Background: Frailty is associated with significant morbidity and mortality in older adults. Whether frailty predicts adverse outcomes after percutaneous left atrial appendage closure (LAAC) remains uncertain.

Objective: The purpose of this study was to examine the association between frailty and clinical outcomes after percutaneous LAAC.

Methods: We identified patients 65 years and older in Medicare fee-for-service claims who underwent LAAC between October 1, 2016, and December 31, 2019. Patients were identified as frail on the basis of the Hospital Frailty Risk Score (HFRS), a validated frailty measure centered on health resource utilization, with the cohort stratified into low (<5), intermediate (5-15), and high (>15) risk groups.

Results: Of the 21,787 patients who underwent LAAC, 10,740 (49.3%) were considered frail (HFRS >5), including 3441 (15.8%) in the high-risk group. The mortality rate (up to 1095 days) were 16.1% in the low-risk group, 26.7% in the intermediate-risk group, and 41.1% in the high-risk group (P < .001). After adjusting for age, sex, and comorbidities, HFRS >15 (compared with HFRS <5) was associated with a higher risk of long hospital stay (odds ratio [OR] 8.29; 95% confidence interval [CI] 5.94-11.57), 30-day readmission (OR 1.80, 95% CI 1.58-2.05), 30-day mortality (OR 5.68, 95% CI 3.40-9.40), and 1-year mortality (OR 2.83, 95% CI 2.39-3.35). In restricted cubic spline models, the adjusted OR for all outcomes monotonically increased with increasing HFRS.

Conclusion: Frailty is common in patients undergoing LAAC and is associated with increased risks of long hospital stay, readmissions, and short-term mortality.

Keywords: Atrial fibrillation; Claims data; Frailty; Left atrial appendage closure; Outcomes research.

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Conflict of interest statement

Disclosures: The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of the study cohort. FFS = fee-for-service; LAAC = left atrial appendage closure.
Figure 2
Figure 2
Kaplan-Meier curve for long-term mortality according to Hospital Frailty Risk Score categories.
Figure 3
Figure 3
Association of the Hospital Frailty Risk Score (5 is the reference standard) with (A) 30-day mortality, (B) 1-year mortality, (C) long hospital stay, and (D) 30-day readmissions in patients undergoing percutaneous left atrial appendage closure.
See this image and copyright information in PMC

References

    1. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 2014;129:837–847. - PMC - PubMed
    1. Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014;383:955–962. - PubMed
    1. O ‘Brien EC, Holmes DN, Ansell JE, et al. Physician practices regarding contraindications to oral anticoagulation in atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry. Am Heart J 2014;167:601–609.e601. - PubMed
    1. Kakkar AK, Mueller I, Bassand JP, et al. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry. PLoS One 2013;8:e63479. - PMC - PubMed
    1. Wilkinson C, Todd O, Clegg A, Gale CP, Hall M. Management of atrial fibrillation for older people with frailty: a systematic review and meta-analysis. Age Ageing 2019;48:196–203. - PMC - PubMed