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Frailty and associated outcomes in patients undergoing percutaneous left atrial appendage occlusion: findings from the NCDR LAAO registry

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A Correction to this article was published on 29 November 2023

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Abstract

Background

Frailty is associated with significant morbidity and mortality and may have clinical implications in an advanced age population with atrial fibrillation undergoing left atrial appendage occlusion (LAAO). We sought to develop a novel frailty scale to predict worse outcomes in patients undergoing LAAO.

Methods

Patients in the NCDR LAAO Registry between 2016 and 2021 receiving percutaneous LAAO devices were categorized as non-frail (0 points), pre-frail (1–3 points), or frail (4–5 points) based on a 5-point scale representing multiple domains of frailty: hemoglobin <13.0 g/dL in male, <12.0 g/dL in female; creatinine ≥1.2 mg/dL; albumin <3.5 g/dL; body mass index <20 kg/m2; and increased risk of falls.

Results

Of 57,728 patients, 44,360 (76.8%) were pre-frail and 7693 (13.3%) were frail. Compared to non-frail, pre-frail and frail patients were older, had a higher burden of co-morbidities, and more disability based on the Modified Rankin Scale. Compared to non-frail patients after adjustment, frail patients were at higher risk of in-hospital major complication (OR 1.29, 95% 1.02–1.62, p = 0.01), any complication (OR 1.29, 95% CI 1.09–1.52, p = 0.0005), and death (OR 5.79, 95% CI 1.75–19.17, p = 0.001), while no difference was observed in pre-frail patients. At 45-day follow-up, there was no difference in the risk of complications in frail patients as compared to non-frail, although mortality was significantly higher (OR 3.01, 95% CI 1.97–4.85, p < 0.0001).

Conclusion

A simple and practical frailty scale accurately predicts adverse events in patients undergoing LAAO. The 13% of patients considered frail were at significantly higher risk of in-hospital adverse events and 45-day mortality.

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Data Availability

To be requested through NCDR.

Change history

Abbreviations

LAAO:

Left atrial appendage occlusion

AF:

Atrial fibrillation

NCDR:

National Cardiovascular Data Registry

DOAC:

Direct oral anticoagulant therapy

DAPT:

Dual antiplatelet therapy

TAVR:

Transaortic valve replacement

HFRS:

Hospital Frailty Risk Score

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Funding

This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry (NCDR).

Author information

Authors and Affiliations

  1. Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA

    Douglas Darden, Naga Venkata K. Pothineni, Rakesh Gopinathannair, Rajesh Kabra & Dhanunjaya Lakkireddy

  2. Division of Cardiology, Department of Medicine, University of California Davis, Sacramento, CA, USA

    M. Bilal Munir

  3. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA

    Sarah Zimmerman & James V. Freeman

  4. Western Washington Medical Group, Everett, WA, USA

    Michael Eskander

  5. Midwest Heart and Vascular Specialists, HCA Midwest Health, Kansas City, MO, USA

    Thao Duong

  6. Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA

    Frederick T. Han & Jonathan C. Hsu

Authors
  1. Douglas Darden
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Corresponding author

Correspondence to Douglas Darden.

Ethics declarations

Informed consent and ethics approval

Waiver of written informed consent and authorization for NCDR studies were granted by Chesapeake Research Review Incorporated. The research in this study was conducted according to the Helsinki Declaration guidelines on human research.

Conflict of interest

Dr. Hsu reports receiving honoraria from Medtronic, Abbott, Boston Scientific, Biotronik, Janssen Pharmaceuticals, Bristol-Myers Squibb, Pfizer, Sanofi, Zoll Medical, Hillrom, iRhythm, Acutus Medical, Galvanize Therapeutics, and Biosense-Webster, has research grants from Biotronik and Biosense-Webster, and has equity interest in Vektor Medical.

Dr. Freeman has received salary support from the American College of Cardiology NCDR and the National Heart, Lung, and Blood Institute; has received consulting/Advisory Board fees (modest) from Boston Scientific, Medtronic, Janssen Pharmaceuticals, and Biosense Webster; and has equity interest in PaceMate.

Dr. Lakkireddy reports receiving honoraria from Abiomed, Biosense Webster, Boston Scientific, Biotronik, Janssen, and Abbott Medical.

Dr. Gopinathannair reports receiving Honoria from Abbott Medical, Boston Scientific, Pfizer, and Zoll Medical; Advisory board: Pacemate (no compensation).

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The original online version of this article was revised: In this article the author name M. Bilal Munir was incorrectly written as Bilal M. Munir.

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Darden, D., Bilal Munir, M., Zimmerman, S. et al. Frailty and associated outcomes in patients undergoing percutaneous left atrial appendage occlusion: findings from the NCDR LAAO registry. J Interv Card Electrophysiol 67, 625–635 (2024). https://doi.org/10.1007/s10840-023-01662-1

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