Frailty in patients undergoing percutaneous left atrial appendage closure: The Frail-LAAC study

The prevalence and impact of frailty in patients undergoing left atrial appendage closure (LAAC) remain unknown.

This study aimed to evaluate the prevalence and prognostic implications of frailty in patients undergoing LAAC.

The Frail-LAAC trial was an international, multicenter, prospective study that included consecutive patients undergoing LAAC in 4 university centers (2022-2024). Frailty was assessed preprocedurally using the Essential Frailty Toolset (EFT) and defined as an EFT score of ≥3 (and prefrail as an EFT of 1-2). Clinical outcomes were evaluated at follow-up.

A total of 452 consecutive patients were included (mean age 76 ± 8 years; 34% of women), and frailty was identified in 101 of them (22.4%). Frail patients were older, were more commonly female, and had a higher comorbidity burden. Device success (99.6%) and procedural success (97.3%) were high across all groups, without differences in procedure-related complications (P =.188). After a median follow-up of 12 (4-22) months, frail patients had a higher rate of all-cause mortality or ischemic events compared to nonfrail patients (36.6% vs 9.4%; adjusted hazard ratio [HR] 4.85; 95% confidence interval [CI] 2.85-8.24; P < .001), primarily driven by an increased mortality risk (33.7% vs 7.7%; adjusted HR 5.28; 95% CI 2.94-9.46; P < .001). In contrast, prefrailty was not associated with mortality compared with robust patients (adjusted HR 2.87; 95% CI 0.83-9.98; P = .115). The inclusion of frailty in predictive models significantly improved mortality risk stratification.

Frailty is common in patients undergoing LAAC and is associated with a 5-fold increased mortality risk. Incorporating frailty assessment into preprocedural evaluations enhanced risk stratification, highlighting the need for careful patient selection, particularly in those with advanced frailty, to optimize outcomes and avoid futile interventions.