Diaz-Arocutipa Carlos, Calderon-Ramirez Pablo M, Mayta-Tovalino Frank, Torres-Valencia Javier
Unidad de Revisiones Sistemáticas y Meta-análisis, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.
A-HEART Andean Heart Research Network, Lima, Peru.
Heart Rhythm O2. 2023 Dec 24;5(2):85-94. doi: 10.1016/j.hroo.2023.12.007. eCollection 2024 Feb.
Leadless pacing has recently emerged as a promising therapy. The impact of frailty on the prognosis of these patients is currently unknown.
The purpose of this study was to assess the association between frailty and clinical outcomes in patients undergoing leadless pacemaker implantation.
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.
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.
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.
无导线起搏最近已成为一种有前景的治疗方法。目前尚不清楚衰弱对这些患者预后的影响。
本研究的目的是评估接受无导线起搏器植入患者的衰弱与临床结局之间的关联。
我们纳入了2017年至2019年使用全国住院患者样本接受无导线起搏器植入的成年患者。使用医院衰弱风险评分评估衰弱情况，并分为低、中、高风险。主要结局是住院死亡率和任何并发症（血管、心包、气胸、感染或与器械相关的并发症），次要结局是住院时间和总费用。
最终分析共纳入16,825例患者，其中62%处于衰弱的中高风险。与低风险患者相比，高风险（调整风险比[aRR]6.37，95%置信区间[CI]3.31 - 12.26）或中风险（aRR 5.15，95%CI 3.04 - 8.72）的衰弱患者住院死亡率更高。同样地，衰弱中高风险的患者总费用更高，住院时间更长。高风险（aRR 1.14，95%CI 0.71 - 1.81）或中风险（aRR 1.19，95%CI 0.94 - 1.51）的衰弱患者发生任何并发症的风险与低风险患者相似。
接受无导线起搏器植入的患者中衰弱很常见。除任何并发症外，较高程度的衰弱是住院死亡率、住院时间和住院费用的有力预测因素。
