Frail patients undergoing alcohol septal ablation for HOCM had a significantly higher risk of 10-year all-cause mortality compared with nonfrail patients (HR 1.40; 95% CI 1.26-1.55; P<0.001).
Cohort (n=39,063)
Yes
Does frailty increase mortality and adverse clinical outcomes in patients undergoing alcohol septal ablation for hypertrophic obstructive cardiomyopathy?
Frail patients undergoing alcohol septal ablation for HOCM have a significantly higher risk of long-term mortality and adverse cardiovascular events compared to nonfrail patients.
Effect estimate: HR 1.40 (95% CI 1.26-1.55)
p-value: p=<0.001
Background There are limited data on the impact of frailty in patients undergoing alcohol septal ablation (ASA) for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). Objectives The objective of the study was to evaluate the impact of frailty on long-term clinical outcomes in patients undergoing ASA for HOCM. Methods Using the United States Collaborative Network (2005-2025), we identified patients with HOCM undergoing ASA and stratified them into frail and nonfrail groups based on the Johns Hopkins Adjusted Clinical Group frailty-defining diagnosis. Propensity-score matching (1:1) was applied to adjust for baseline differences in demographics, comorbidities, medications, and labs. Kaplan-Meier analysis and Cox proportional hazards regression were used to estimate HRs using the built-in R-computing software (v3.2 to 3). The primary outcome was all-cause mortality at various follow-ups post-ASA (1-, 3-, 5-, and 10 years). Results Among 39,063 patients undergoing ASA, 2,264 (5.8%) were frail. Post-propensity-score matching, 2,219 patients were matched per group. Frail patients demonstrated higher all-cause mortality at all follow-ups (10-year HR: 1.40; 95% CI: 1.26–1.55; P < 0.001). Frail patients also demonstrated a higher risk of major adverse cardiac and cerebrovascular event (HR: 1.49; 95% CI: 1.30–1.70; P < 0.001), ischemic stroke (HR: 1.57; 95% CI: 1.24–2.00; P < 0.001), heart failure exacerbation (HR: 1.09; 95% CI: 1.01–1.19; P = 0.024), major bleeding (HR: 1.61; 95% CI: 1.38–1.88; P < 0.001), and all-cause readmission (HR: 1.33; 95% CI: 1.24–1.43; P < 0.001) compared with nonfrail patients at 1-year post-ASA. No differences were noted for acute myocardial infarction, sudden cardiac arrest, antiarrhythmic drugs initiation/escalation, or electrical cardioversion. Conclusions Frail patients undergoing ASA for HOCM exhibit higher risks of long-term mortality and adverse clinical outcomes compared with their nonfrail counterparts.
Jain et al. (Fri,) conducted a cohort in Hypertrophic obstructive cardiomyopathy (HOCM) (n=39,063). Frail vs. Nonfrail was evaluated on All-cause mortality at 1-, 3-, 5-, and 10 years post-ASA (HR 1.40, 95% CI 1.26-1.55, p=<0.001). Frail patients undergoing alcohol septal ablation for HOCM had a significantly higher risk of 10-year all-cause mortality compared with nonfrail patients (HR 1.40; 95% CI 1.26-1.55; P<0.001).
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