Frailty and Associated Outcomes in Patients Undergoing Left Atrial Appendage Occlusion: NCDR LAAO Registry

Purpose: Frailty is associated with significant morbidity and mortality, although has limited clinical applicability as no consensus exists on measurement. We sought to develop a novel frailty scale to predict outcomes in patients undergoing percutaneous left atrial appendage occlusion (LAAO).

Material and Methods: Patients in the NCDR LAAO Registry between 2016-2021 receiving Watchman 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 men, < 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 the 57,728 patients, 44,360 (76.8%) were pre-frail and 7,693 (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 major complication (OR 1.29, 95% 1.02 – 1.62, 0.01), any complication (OR 1.29, 95% CI 1.09 – 1.52, 0.0005), and death (OR 5.79, 95% CI 1.75 – 19.17, 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).

Conclusions: A simple, practical, and novel 5-point frailty scale can accurately predict in-hospital 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.