Impact of frailty on mortality and adverse events after durable left ventricular assist device implantation: Insights from the J-MACS registry

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.