Impact of Frailty in Patients With Continuous-Flow Left Ventricular Assist Device Therapy in End-Stage Heart Failure: A Systematic Review and Meta-Analysis

Background: Frailty, marked by increased vulnerability and reduced physiological reserve, is common in end-stage heart failure patients. Continuous flow left ventricular assist devices (LVADs) have improved outcomes, but the impact of frailty on these outcomes is unclear. This systematic review and meta-analysis investigate the effect of frailty on clinical outcomes in patients undergoing LVAD therapy. Methods: Following PRISMA guidelines, we searched PubMed, Cochrane, EMBASE, MEDLINE, and Google Scholar up to September 2023 for studies comparing frail and non-frail patients undergoing LVAD implantation. Data on mortality, hospital length of stay, intubation duration, bleeding, infection, and readmission rates were extracted and analyzed using the Mantel–Haenszel random-effects model, with heterogeneity assessed by the I2 statistic. Results: Fifteen studies involving 3458 patients were included. Frailty was significantly associated with higher long-term mortality (OR: 2.12; 95% CI: 1.17–3.83; p = 0.01), but not with short-term mortality (OR: 1.61; 95% CI: 0.71–3.65; p = 0.26), hospital length of stay (MD: 1.93; 95% CI: -9.83 to 13.68; p = 0.75), or intubation duration (MD: 34.28; 95% CI: -1.15–69.71; p = 0.06). No significant differences were found in bleeding (OR: 1.76; 95% CI: 0.76–4.10; p = 0.19), infection (OR: 0.44; 95% CI: 0.11–1.84; p = 0.26), or readmission rates (OR: 1.07; 95% CI: 0.78–1.46; p = 0.68). Conclusion: Frail patients with LVADs have higher long-term mortality but similar short-term outcomes, hospital stays, intubation times, bleeding, infection, and readmission rates compared to non-frail patients. These findings highlight the need for tailored strategies to improve outcomes in frail LVAD patients and suggest further research on frailty interventions.