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. 2024 Nov 7;3(11):101358.
doi: 10.1016/j.jacadv.2024.101358. eCollection 2024 Nov.

The Impact of Frailty on Patients With AF and HFrEF Undergoing Catheter Ablation: A Nationwide Population Study

Justin D Mark  1 , Rosario A Colombo  2 , Carlos E Alfonso  2 , Alexander Llanos  3 , Elias Collado  3 , Joshua M Larned  3 , German Giese  1 , Michael D Dyal  2 , Michael G Nanna  4 , Abdulla A Damluji  5
Affiliations

The Impact of Frailty on Patients With AF and HFrEF Undergoing Catheter Ablation: A Nationwide Population Study

Justin D Mark et al. JACC Adv. .

Abstract

Background: Frailty is a common geriatric syndrome often coexisting with cardiovascular diseases such as atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction (HFrEF). While catheter ablation (CA) has demonstrated efficacy in reducing major adverse cardiovascular events and improving mortality and quality of life, the influence of frailty among this population remains unknown.

Objectives: The authors aimed to identify the prevalence of frailty among patients with HFrEF and AF undergoing CA and its influence on cardiovascular mortality and discharge disposition.

Methods: From January 2016 to December 2019, we used the Nationwide Inpatient Sample to identify patients with AF and HFrEF. Frailty was identified by the presence of ≥1 diagnostic cluster utilizing the Johns Hopkins Adjusted Clinical Groups with malnutrition, dementia, impaired vision, decubitus ulcer, urinary incontinence, loss of weight, poverty, barriers to access to care, difficulty walking, and falls as indicators. We compared clinical outcomes among frail vs nonfrail patients, including all-cause in-hospital mortality, major adverse cardiovascular events, other major complications, discharge disposition, and hospital length of stay using multivariable regression analysis.

Results: Of 113,115 weighted admissions, 11,725 (10.4%) were classified as frail. Frail patients were older (median age: 76 [IQR: 15] years vs 70 [IQR: 15] years, P < 0.001) than nonfrail patients. Frailty was associated with increased odds of all-cause hospital mortality (adjusted odds ratio [aOR]: 2.64; 95% CI: 1.87-3.72; P < 0.001), major adverse cardiovascular events (aOR: 2.00; 95% CI: 1.62-2.47; P < 0.001), and nonhome discharge (aOR: 3.31; 95% CI: 2.78-3.94; P < 0.001). Frail patients also experienced longer hospital length of stay (median 9 [IQR: 10] days vs 5 [IQR: 5] days, P < 0.001) after adjustment by Poisson regression (coefficient: 0.53; 95% CI: 0.46-0.59; P < 0.001).

Conclusions: Frailty is associated with worse outcomes in patients with HFrEF undergoing CA for AF. The integration of frailty models in clinical practice may facilitate prognostication and risk stratification to optimize patient selection for CA.

Keywords: atrial fibrillation; catheter ablation; frailty; older adults; outcomes research; systolic heart failure.

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Conflict of interest statement

This study was partially funded by a mentored patient-oriented research career development award from the 10.13039/100000050National Heart, Lung, and Blood Institute (K23-HL153771-01). Dr Nanna has received research support from the 10.13039/100005485American College of Cardiology Foundation, supported by the George F. and Ann Harris Bellows Foundation, the 10.13039/100006093Patient-Centered Outcomes Research Institute (PCORI), the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342), and the 10.13039/100000049National Institute on Aging/10.13039/100000002National Institutes of Health from R03AG074067 (GEMSSTAR award). Dr Damluji has received research funding from the Pepper Scholars Program of the 10.13039/100007880Johns Hopkins University Claude D. Pepper Older Americans Independence Center funded by the 10.13039/100000049National Institute on Aging P30-AG021334 and a mentored patient-oriented research career development award from the National Heart, Lung, and Blood Institute K23-HL153771-01. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Flow Diagram for Study Inclusion Criteria ACG = adjusted clinical groups; AF = atrial fibrillation; CA = catheter ablation; HFrEF = heart failure with reduced ejection fraction; ICD = International Classification of Disease.
Figure 2
Figure 2
Forest Plot With Odds Ratios and Their Respective 95% CI Depicting Clinical Variables Association With Mortality ∗Statistically significant at P < 0.05.
Central Illustration
Central Illustration
Impact of Frailty in Patients Undergoing Catheter Ablation for Atrial Fibrillation With Underlying Heart Failure With Reduced Ejection Fraction
See this image and copyright information in PMC

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