Impact of Frailty on Left Ventricular Assist Device Clinical Outcomes

Steven Imburgio, Ndausung Udongwo, Anton Mararenko, Anmol Johal, Medin Tafa, Hira Akhlaq, Sowmya Dandu, Mohammad Hossain, Abbas Alshami, Brett Sealove, Jesus Almendral, Joseph Heaton

Research output: Contribution to journalArticlepeer-review

Abstract

Frailty is a clinical syndrome prevalent in older adults and carries poor outcomes in patients with heart failure. We investigated the impact of frailty on left ventricular assist device (LVAD) clinical outcomes. The Nationwide Readmission Database was used to retrospectively identify patients with a primary diagnosis of heart failure who underwent LVAD implantation during their hospitalization from 2014 to 2020. Patients were categorized into frail and nonfrail groups using the Hospital Frailty Risk Score. Cox and logistic regression were used to predict the impact of frailty on inpatient mortality, 30-day readmissions, length of stay, and discharge to a skilled nursing facility. LVADs were implanted in 11,465 patients who met the inclusion criteria. There was more LVAD use in patients who were identified as frail (81.6% vs 18.4%, p <0.001). The Cox regression analyses revealed that LVAD insertion was not associated with increased inpatient mortality in frail patients (hazard ratio 1.15, 95% confidence interval 0.81 to 1.65, p = 0.427). Frail patients also did not experience a higher likelihood of readmissions within 30 days (hazard ratio 1.15, 95% confidence interval 0.91 to 1.44, p = 0.239). LVAD implantation did not result in a significant increase in inpatient mortality or readmission rates in frail patients compared with nonfrail patients. These data support continued LVAD use in this high-risk patient population.

Original languageEnglish
Pages (from-to)69-74
Number of pages6
JournalAmerican Journal of Cardiology
Volume207
DOIs
StatePublished - 15 Nov 2023
Externally publishedYes

Keywords

  • frailty
  • heart failure
  • left ventricular assist device
  • length of stay
  • mortality
  • readmission

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