Abstract 4365954: Outcomes Following Left Atrial Appendage Closure in Older Adults with Different Levels of Frailty

Abstract

Background: Patients who are older and those that are frail are routinely referred for LAAC but may be at increased risk of adverse events following device implant. It is unclear how age and frailty interact and if measures of frailty can support risk stratification in older adults. Research Question: Will measures of frailty improve risk stratification for LAAC in older adults? Methods: The WATCHMAN FLX Pro Device SURveillance Post Approval AnalySiS Plan (SURPASS Pro) is a multicenter, prospective, observational analysis that acquires data from the NCDR LAAO Registry. Patients discharged Oct 2023 – Jun 2024 with an attempted WATCHMAN FLX Pro implant were stratified by age (≥80 and <80 years) and then by frailty (non-frail, pre-frail, and frail) based on measures of hemoglobin, creatinine, albumin, BMI, and increased fall risk. Key safety events (death, ischemic stroke, systemic embolism, device/procedure-related events through discharge or 7 days, whichever is later) and clinical events through 45 days were assessed. Results: Of 21,595 patients in SURPASS Pro, 8,203 (38.0%) were ≥80 years and 13,392 (62.0%) were <80 years old. The older group had a higher mean CHA 2 DS 2 -VASc score (5.0 ± 1.4 vs 4.3 ± 1.4) and slightly fewer females (39.4% v 43.7%). Implant success was high for both groups (96.3% [≥80] and 97.3% [<80]). Composite occurrence of key safety events was similar (0.27% [≥80] and 0.16% [<80]; p=0.10), but mortality was higher in those ≥80 (0.18% v 0.05%; p<0.01). The older group had 1,394 (17%) non-frail, 6,629 (80%) pre-frail, and 180 (2.2%) frail individuals. Frailty showed a significant association for the key safety endpoint (p<0.01) driven by mortality (Table 1) and frailty was associated with increased 45-day mortality (p<0.01) (Figure 1A). The younger group had 4,104 (31%) non-frail, 9,156 (68%) pre-frail, and 132 (1%) frail individuals. In this group, frailty showed a significant association for the key safety endpoint (p<0.01) driven by ischemic stroke and device or procedure-related events (Table 1). Frailty was also associated with higher rates of 45-day mortality and bleeding in the younger group (Figure 1B). Conclusion: Only 1 in 5 patients ≥80 years undergoing LAAO is non-frail. Age ≥80 years and frailty are associated with higher relative rates of safety events and mortality, though the absolute risks are very low. Frailty and age ≥80 years can help refine clinical risk stratification for LAAC but should not be considered prohibitory.