Impact of frailty in hospitalized patients undergoing catheter ablation for atrial fibrillation

Background: Catheter Ablation (CA) is an effective treatment for atrial fibrillation (AF). However, frail elderly patients have been understudied due to their exclusion from landmark trials. Objectives: Our study aims to evaluate outcomes in this population. Methods: The national readmission database (2016–2020) was queried, and frailty categories were defined based on hospital risk frailty scores ≦5 as low while >5 as intermediate/high frailty (IHF). We used multivariate regression and propensity-matched analysis to compare outcomes in patients undergoing CA for atrial fibrillation based on frailty index. Results: Among 55 936 CAs for AF, 33,248 patients had low frailty, while 22 688 had intermediate/high frailty (IHF). After propensity matching (N 12 448), IHF patients were found to have higher adverse events, including mortality (3% vs. 0.3%, p <.001), stroke (1.9% vs. 0.2%, p <.001), acute heart failure (53.8% vs. 42.2%, p <.001), AKI (42.5% vs. 6.8%, p <.001), pericardial complications (2.8 vs. 1.6%, p <.001), respiratory complications (27.8 vs. 7.2%, p <.001), major adverse cardiovascular events (21.2 vs. 9.4%, p <.001) and net adverse events (76.7 vs. 55%, p <.001). IHF patients had higher readmissions at 30 (15.5 vs. 12.6%, p <.001), 90 (31.9 vs. 25.1%, p <.001), and 180-day (41 vs. 34.7%, p <.001) intervals. A higher median length of stay (LOS) (7 vs. 3 days, p <.001) and cost ($44 287 vs. $27 517, p <.001) at index admission and subsequent readmissions were also observed (p <.001). Conclusion: Intermediate/high frailty patients undergoing catheter ablation had worse clinical outcomes, higher healthcare burden, and readmission rates. LOS has decreased in both groups from 2016 to 2020; however, total cost has increased.