Abstract 12534: Comparative Performance of Distinct Frailty Measures Among Patients Undergoing Percutaneous Left Atrial Appendage Closure

Abstract

Introduction: Frailty is associated with increased morbidity and mortality in patients undergoing left atrial appendage closure (LAAC). We compared the performance of two claims-based frailty measures in predicting adverse outcomes following LAAC. Methods: We identified patients 65 years and older who underwent LAAC between October 1, 2016 and December 31, 2019 in Medicare fee-for-service claims. Frailty was assessed using the previously validated Hospital Frailty Risk Score (HFRS) and Kim Claims-based Frailty Index (CFI). Patients were identified as frail based on HFRS ≥5 and CFI ≥0.25. Results: Of the 21,787 patients who underwent LAAC, frailty was identified in 45.6% by HFRS and 15.4% by CFI. There was modest agreement between the two frailty measures (kappa 0.25, Pearson’s correlation 0.62). After adjusting for age, sex, and comorbidities, frailty was associated with higher risk of 30-day mortality, 1-year mortality, 30-day readmission, long hospital stay, and short time at home (p<0.01 for all) regardless of the frailty instrument used. Model discrimination was similar between the HFRS and the CFI with fair discrimination of all outcomes (C-statistic 0.686 - 0.759). The addition of frailty to standard comorbidities significantly improved model performance to predict 1-year mortality, long hospital stay, and short time at home (Delong p-value <0.001). Conclusions: Despite significant variation in frailty detection and only modest agreement between the two frailty measures, frailty status was highly predictive of mortality, readmission, long hospital stay, and days at home. Future studies should focus on prospective evaluation of frailty in patients eligible for LAAC, which may further refine the relationship between frailty and adverse outcomes, and help inform shared decision-making in this population.