Title : Impact of frailty in patients undergoing continuous-flow left ventricular assist device therapy: A systematic review and meta-analysis
Abstract:
Introduction: Frailty, characterised by reduced physiological reserve and increased vulnerability, is common in end-stage heart failure. Continuous-flow left ventricular assist devices (LVADs) improve outcomes, but the impact of frailty on clinical outcomes remains unclear.
Purpose: To evaluate the effect of frailty on clinical outcomes following LVAD implantation.
Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Cochrane, EMBASE, MEDLINE and Google Scholar were searched up to September 2023. Studies comparing frail versus non-frail patients undergoing LVAD implantation were included. Outcomes included mortality, hospital length of stay, intubation duration, bleeding, infection and readmission. Data were analysed using Mantel–Haenszel random-effects models with heterogeneity assessed using the I² statistic.
Results: Fifteen studies involving 3,458 patients were included. Frailty was associated with higher long-term mortality (OR 2.12; 95% CI 1.17–3.83; p=0.01), but not short-term mortality (OR 1.61; 95% CI 0.71–3.65; p=0.26), hospital length of stay (MD 1.93; 95% CI −9.83 to 13.68; p=0.75), or intubation duration (MD 34.28; 95% CI −1.15 to 69.71; p=0.06). No significant differences were found in bleeding (OR 1.76; p=0.19), infection (OR 0.44; p=0.26), or readmission (OR 1.07; p=0.68).
Conclusion: Frailty is associated with increased long-term mortality after LVAD implantation but not short-term outcomes or perioperative complications. These findings support improved risk stratification and targeted frailty-focused interventions.
