Prevalence, clinical characteristics, and prognostic impact of frailty in patients undergoing implantable cardioverter defibrillator or cardiac resynchronization therapy
Y Naruse, M Fukunaga, M Watanabe, Y Yazaki, Y Orita, H Hasebe, A Mizukami, Y Matsue, H Hayashi, Y Kaneko, M Sano, Y MaekawaAbstract
Background
Implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) are standard therapeutic options in patients with ventricular arrhythmias and chronic heart failure. However, all-cause mortality was higher in elderly patients than in younger patients. This is because non-arrhythmic deaths are more common in the elderly, limiting the effectiveness of defibrillators. Therefore, it is important to evaluate frailty, malnutrition, sarcopenia, and comorbidities when considering the risk of non-arrhythmic death. However, the prevalence, clinical characteristics, and prognostic impact of frailty in patients who underwent ICD implantation or CRT have not been fully investigated.
Purpose
This study aimed to investigate the relationship between frailty and prognosis in elderly patients following ICD or CRT implantation.
Methods
The IDATEN (Implantable carDioverter defibrillATor and cardiac rEsyNchronization therapy) registry was a multicenter, prospective registry that collected detailed data on frailty and sarcopenia in patients undergoing ICD implantation or CRT for tachyarrhythmia or chronic heart failure at 8 tertiary hospitals in Japan from June 2019 to March 2022. The patients whose ages were <60 years old were excluded from this study. Frailty and pre-frailty were defined as a Japan Cardiovascular Health Study Frailty Index (J-CHS-FI) score of greater than 2 and 1–2, respectively. The primary endpoint was the composite endpoint of all-cause death and heart failure hospitalization. A 2-year observation period was established after device implantation.
Results
The present study showed that 24% of patients implanted with an ICD or CRT at the age of 60 years or older had frailty, and 68% if pre-frailty status is included. Age was significantly higher (76±7 vs. 71±7 years, P<0.01), and body mass index was significantly lower (21.0±3.5 vs. 22.8±3.6, P<0.01) in the frailty group than in the non-frailty/pre-frailty group. Serum hemoglobin levels were significantly lower in the frailty group (11.9±1.6 vs. 13.0±1.9, P<0.01), and plasma NT-proBNP (2875 vs. 1119, P<0.01) and plasma BNP (527 vs. 176, P<0.01) were significantly higher in the frailty group.During the median follow-up period of 739 [interquartile range 713–769] days, all-cause death occurred in 8 patients and heart failure hospitalization in 13 patients, respectively. The frailty group was associated with an increased risk of the primary endpoint (p = 0.010 by log-rank test). The frailty group had a higher prevalence of procedural complications (11.4% vs/ 2.4%, p=0.04) and longer duration from operation to discharge (10 [8–13] vs. 8 [7–11] days, p=0.047) compared to the non-frailty/pre frailty group.
Conclusions
The results of this prospective multicenter registry showed that frailty was associated with an increased risk of all-cause mortality and hospitalization for worsening heart failure in ICD or CRT patients.Kaplan-Meier curve