Frailty Burden in Patients with HFrEF Undergoing Ventricular Tachycardia Ablation: Clinical Outcomes and Readmissions

BACKGROUND: Frailty is common and has been associated with adverse clinical outcomes across cardiovascular populations. However, its prognostic significance, particularly the impact of graded frailty burden, among patients with heart failure with reduced ejection fraction (HFrEF) undergoing catheter ablation for ventricular tachycardia (VT) remains incompletely characterized. METHODS: We evaluated the association between frailty burden and in-hospital outcomes among patients with HFrEF undergoing VT ablation using the Nationwide Readmissions Database. Frailty was defined using the validated Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator. Cumulative frailty burden was quantified as the number of domains (range: 0-10). Multivariable logistic regression was used to assess associations with outcomes, and in-hospital mortality probabilities were estimated across increasing frailty burden. RESULTS: Among 17,367 hospitalizations for VT ablation in patients with HFrEF, 7.4% were classified as frail. Frailty was independently associated with higher in-hospital mortality (adjusted odds ratio [aOR], 1.59; 95% CI, 1.19-2.13; p<0.001), and increased complication rates. Frail patients had higher 30-day (13.6% vs. 9.1%) and 90-day (33.7% vs. 28.1%) readmission rates compared with non-frail patients. Frailty burden demonstrated a graded association with in-hospital mortality, with estimated mortality increasing progressively with each additional frailty domain. CONCLUSIONS: Frailty is independently associated with worse in-hospital outcomes and higher readmission rates among patients with HFrEF undergoing VT ablation, with a graded increase in risk across increasing frailty domains. These findings suggest that frailty burden may serve as a clinically relevant risk stratification marker in this vulnerable cohort.