Frailty and Clinical Outcomes in Advanced Heart Failure Patients Undergoing Left Ventricular Assist Device Implantation: A Systematic Review and Meta-analysis

Background: Frailty has been identified as a risk factor for adverse clinical outcomes after cardiac intervention or surgery. However, whether it increases the risk of adverse outcomes in patients undergoing left ventricular assist device (LVAD) therapy has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and clinical outcomes of length of stay and mortality in this setting. Methods: PubMed and Embase were searched until September 11, 2017, for studies evaluating the association between frailty and clinical outcomes in advanced heart failure patients undergoing LVAD implantation. Results: A total of 46 and 79 entries were retrieved from our search strategy. A total of 13 studies involving 3435 patients were included in the final meta-analysis (mean age: 57.7 ± 15.3 years; 79% male, follow-up duration was 13 ± 14 months). Compared to nonfrail patients (n = 2721), frail patients (n = 579) had significantly longer time-to-extubation (n = 3; mean difference: 45 ± 6 hours; I²: 0%) and hospital length of stay (n = 4; mean difference: 2.9 ± 1.2 days; P =.001; I²: 21%). Frailty was not a predictor of inpatient or short-term mortality [n = 3; hazard ratio (HR): 1.22, 95% confidence interval (CI): 0.66-2.26; P >.05; I²: 0%] but predicted long-term mortality (n = 7; HR: 1.44, 95% CI: 1.15-1.80; P =.001; I²: 0%). Conclusions: Frailty leads to significantly longer time to extubation, hospital length of stay, and long-term mortality in advanced heart failure patients who have undergone LVAD implantation. Older patients being considered for LVAD implantation should therefore be assessed for frailty status. The risk and benefit of the procedure should be explained to the patient, emphasizing that frailty increases the likelihood of adverse clinical outcomes.