Impact of Frailty in Patients With Continuous-Flow Left Ventricular Assist Device Therapy in End-Stage Heart Failure: A Systematic Review and Meta-Analysis.

BACKGROUND

Frailty, marked by increased vulnerability and reduced physiological reserve, is common in end-stage heart failure patients. Continuous flow left ventricular assist devices (LVADs) have improved outcomes, but the impact of frailty on these outcomes is unclear. This systematic review and meta-analysis investigate the effect of frailty on clinical outcomes in patients undergoing LVAD therapy.

METHODS

Following PRISMA guidelines, we searched PubMed, Cochrane, EMBASE, MEDLINE, and Google Scholar up to September 2023 for studies comparing frail and non-frail patients undergoing LVAD implantation. Data on mortality, hospital length of stay, intubation duration, bleeding, infection, and readmission rates were extracted and analyzed using the Mantel-Haenszel random-effects model, with heterogeneity assessed by the I2 statistic.

RESULTS

Fifteen studies involving 3458 patients were included. Frailty was significantly associated with higher long-term mortality (OR: 2.12; 95% CI: 1.17-3.83; p = 0.01), but not with 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: -1.15-69.71; p = 0.06). No significant differences were found in bleeding (OR: 1.76; 95% CI: 0.76-4.10; p = 0.19), infection (OR: 0.44; 95% CI: 0.11-1.84; p = 0.26), or readmission rates (OR: 1.07; 95% CI: 0.78-1.46; p = 0.68).

CONCLUSION

Frail patients with LVADs have higher long-term mortality but similar short-term outcomes, hospital stays, intubation times, bleeding, infection, and readmission rates compared to non-frail patients. These findings highlight the need for tailored strategies to improve outcomes in frail LVAD patients and suggest further research on frailty interventions.