Clinical Outcomes Following Invasive Cardiovascular Interventions in Frail Populations: A Systematic Review and Meta-analysis

Background Frailty is highly prevalent in cardiovascular disease and associates with poor clinical outcomes. Several cardiovascular conditions benefit from invasive interventions, but the impact of these procedures in frail patients remains unclear. Objective We performed a systematic review and meta-analysis to summarize evidence and quantify the pooled effect of clinical outcomes of invasive cardiovascular interventions among frail vs non-frail patients. Methods Systematic search of 2 electronic databases from January 2015 to April 2025 was performed. All randomized controlled trials (RCTs) and prospective cohort studies examining outcomes of invasive cardiovascular interventions stratified by frailty were included. Outcomes included all-cause mortality, hospitalizations, and other adverse outcomes. Risk ratios (RRs) and their 95% confidence intervals (CI) were assessed using random-effects models. Results Thirty-one studies (10 RCTs, 21 prospective, 3 retrospective studies) with a total of 27,534 participants were included. Compared with non-frail patients, frail patients after cardiovascular procedures were at higher risks of all-cause mortality (RR 3.14, 95% CI 2.29–4.30), and hospitalizations (RR 1.88, 95% CI 1.29-2.73). Frail patients undergoing transcatheter aortic-valve implantation and percutaneous mitral-valve interventions did not have significant increased mortality risks compared to non-frail patients (p>0.05). Pre-frailty predicted lower mortality risks amongst patients undergoing transcatheter vs surgical aortic valve replacement (HR 0.78, 95% CI 0.67-0.92). Frail patients with non-ST elevation myocardial infarction derived similar mortality benefits from an invasive vs conservative approach (HR 1.13, 95% CI 0.64-2.01). Conclusion Frailty prognosticates adverse outcomes following invasive cardiovascular interventions and influences treatment efficacy, highlighting its significance in treatment selection.