Association between frailty and in-hospital outcomes in patients undergoing leadless pacemaker implantation: A nationwide analysis

Background: Leadless pacing has recently emerged as a promising therapy. The impact of frailty on the prognosis of these patients is currently unknown. Objective: The purpose of this study was to assess the association between frailty and clinical outcomes in patients undergoing leadless pacemaker implantation. Methods: We included adult patients who underwent leadless pacemaker implantation using the National Inpatient Sample from 2017 to 2019. Frailty was evaluated using the Hospital Frailty Risk Score and stratified into low, intermediate, and high risk. Primary outcomes were in-hospital mortality and any complication (vascular, pericardial, pneumothorax, infectious, or device related), and secondary outcomes were the length of hospital stay and total charges. Results: A total of 16,825 patients were included in the final analysis, with 62% at intermediate or high risk of frailty. There was a higher risk of in-hospital mortality in patients at high (adjusted risk ratio [aRR] 6.37, 95% confidence interval [CI] 3.31–12.26) or intermediate (aRR 5.15, 95% CI 3.04–8.72) risk of frailty compared with those at low risk. Similarly, those at high or intermediate risk of frailty had higher total expenses and stayed in the hospital longer. Patients with a high (aRR 1.14, 95% CI 0.71–1.81) or intermediate (aRR 1.19, 95% CI 0.94–1.51) risk of frailty had a similar risk of any complication as patients with a low risk. Conclusion: Frailty was common in patients undergoing leadless pacemaker implantation. Higher levels of frailty were a strong predictor of in-hospital mortality, length of hospital stay, and hospital charges, except for any complication.