Utility of the Modified Frailty Index to Predict Cardiac Resynchronization Therapy Outcomes and Response

Area of Science:

• Cardiology
• Geriatrics
• Health Outcomes Research

Background:

• Cardiac resynchronization therapy (CRT) improves outcomes in heart failure patients.
• Frailty is an increasingly recognized predictor of adverse outcomes in various medical conditions.

Purpose of the Study:

• To evaluate the modified frailty index (mFI) as a predictor of clinical outcomes in patients undergoing CRT device implantation.
• To assess the association between preprocedural frailty status and mortality, adverse events, hospital readmission, and CRT response.

Main Methods:

• Retrospective cohort study of 283 patients undergoing CRT implantation or upgrade over 5 years.
• Utilized an 11-component modified frailty index (mFI) to classify patients as frail (mFI ≥3) or non-frail.
• Analyzed associations between mFI and 1-year mortality, periprocedural/30-day adverse events, 30-day readmission, length of stay, and echocardiographic response to CRT.

Main Results:

• Nearly half (47.3%) of patients were classified as frail (mFI ≥3).
• Frailty was significantly associated with increased 1-year mortality (HR 5.87), adverse events, 30-day readmission, and longer hospital stays.
• Frail patients exhibited significantly poorer echocardiographic response to CRT, with smaller improvements in left ventricular ejection fraction and end-diastolic volume.

Conclusions:

• Preprocedural frailty, as measured by the mFI, is a significant predictor of adverse clinical outcomes following CRT implantation.
• Frailty is linked to increased mortality, complications, prolonged hospitalization, and diminished therapeutic response to CRT.
• The mFI can aid in risk stratification and patient selection for CRT.