Impact of Frailty on Mortality and Adverse Events After Durable Left Ventricular Assist Device Implantation: Insights...

Frailty is a multidimensional syndrome associated with adverse outcomes in heart failure. However, its prognostic significance in patients with advanced heart failure receiving a durable left ventricular assist device (LVAD) remains unclear. This study aimed to investigate the association of frailty status with mortality and adverse events using a nationwide cohort of patients undergoing durable LVAD implantation.

We analyzed data from the Japanese Registry for Mechanically Assisted Circulatory Support, including patients who underwent durable LVAD implantation between June 2010 and December 2023. Frailty status was assessed at 3 months after LVAD implantation using the frailty index (FI), which is based on the Rockwood cumulative deficits approach.

In total, 508 patients (34.8%) were classified as not frail (FI ≤ 0.210), 669 (45.9%) as more frail (FI = 0.211-0.310), and 281 (19.3%) as most frail (FI ≥ 0.311). During a median follow-up of 1237 days, 230 patients (15.8%) died. Compared with patients in the nonfrail group, those in the more frail or most frail groups had a higher risk of all-cause death (more frail: adjusted hazard ratio [HR] 2.04 [95% confidence interval (CI), 1.39-3.01]; most frail: 4.98 [95% CI, 3.34-7.43]). In addition, greater frailty was linked to an increased risk of hemocompatibility-related adverse events and right ventricular failure, but not driveline or pump infection, ventricular arrhythmia, or pump malfunction.

Frailty after LVAD implantation is highly prevalent and is associated with long-term mortality and other clinically relevant outcomes. A comprehensive frailty assessment may help to stratify long-term risk after durable LVAD implantation.