Frailty in patients undergoing percutaneous left atrial appendage closure

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. 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. The purpose of this study was to examine the association between frailty and clinical outcomes after percutaneous LAAC. 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. 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. Frailty is common in patients undergoing LAAC and is associated with increased risks of long hospital stay, readmissions, and short-term mortality.