Frailty Increases the Risk of Mortality, Complications in Patients With HFrEF Following Cardiac Implant Placement

Frailty significantly increases the risk of both in-hospital mortality and post-procedural complications in heart failure with reduced ejection fraction (HFrEF) patients following cardiac implantable electronic device (CIED) placement, according to a study being presented at AHA 2024.

In this retrospective cohort study, researchers used the 2020 National Inpatient Sample database from the Healthcare Utilization Project to analyze 24,809 patients aged 18 years or older with HFrEF who underwent CRT-D or ICD placement, identified using ICD-10 procedure codes. The main study measure was frailty, which the researchers classified using a HFRS score of ≥5 (frail) or <5 (not frail). The primary end point of interest was in-hospital mortality, and the secondary outcomes were the composite of post-procedural complications.

The findings showed that in-hospital mortality was higher in frail patients compared to non-frail patients (2% vs 0.3%, p<0.001). Overall, the researchers observed that frail patients had higher odds of in-hospital mortality compared to the non-frail group subset (OR=5.97; 95% CI: 2.77-12.88, p<0.001). Moreover, they noted frailty was correlated with higher odds of post-procedural complications (OR=1.28; 95% CI: 1.01-1.63, p<0.001), increased length of stay (5 vs 11.6 days, p<0.001), and total hospital charges (215,668 vs 324,474 , p<0.001).

“Frailty significantly increases the risk of in-hospital mortality and post-procedural complications in HFrEF patients. This highlights the importance of considering frailty as part of a pre-procedural risk stratification assessment and tailoring management strategies to improve outcomes for these high-risk patients,” the researchers concluded.

Reference

Ramirez A, Malkani S, Aryal B, Jha V. Frailty increases the risk of in-hospital mortality and post-procedural complications in patients undergoing Cardiac Implantable Electronic Devices placement. Abstract #Sa3093. Presented at the American Heart Association Scientific Sessions 2024; November 16-18, Chicago, Illinois.