Implications of Frailty Among Men With Implantable Cardioverter Defibrillators

Katherine Picel, MD; Tien N. Vo, MS; Jessica Kealhofer, MD; Vidhu Anand, MD; Kristine E. Ensrud, MD, MPH; Selcuk Adabag, MD, MS

Disclosures

South Med J. 2020;113(9):427-431. 

In This Article

Abstract and Introduction

Abstract

Objectives: Frailty is associated with adverse outcomes, but little is known of the impact of frailty on patients with implantable cardioverter defibrillators (ICDs). This study sought to determine the prevalence of frailty, based on quantitative assessment, and assessed its potential impact on outcomes among community-dwelling men with ICDs.

Methods: A total of 124 ICD-treated men presenting for a routine device clinic appointment between May and October 2016 underwent frailty assessment consisting of three components: shrinking (weight loss ≥5% during the past year), weakness (inability to rise from a chair without using their arms), and self-reported poor energy level. Patients who had no components were considered robust, those with 1 component were intermediate stage, and those with ≥2 components were deemed frail.

Results: Mean age was 70.4 (±9.7) years. Of the 124 men, 31 (25%) were considered to be frail, 65 (52%) were intermediate, and 28 (23%) were robust. Frail men were older and were more likely to have symptomatic heart failure, chronic kidney disease, and hypertension (P < 0.05 for all) compared with nonfrail men. During a follow-up of 16 months, frail men were significantly more likely to die compared with nonfrail men (29% vs 5.4%, P < 0.0003). The incidence of appropriate ICD shocks (16.1% vs 6.5%) or hospitalizations (38.7% vs 23.7%) tended to be higher among frail versus nonfrail patients, but neither reached statistical significance (P = 0.10).

Conclusions: Almost one-fourth of men with ICD are frail. Almost one-third of frail ICD patients died within 16 months. It may be useful to assess frailty in patients with ICD.

Introduction

The efficacy of implantable cardioverter defibrillators (ICDs) for prolonging the lives of older individuals and patients with comorbidity and/or disability has been called into question.[1–7] In particular, although frailty has been associated with poorer outcomes in general, there are few data on the prevalence, correlates, and implications of frailty among ICD-treated patients.[8–10]

Defined as a syndrome of decreased physical reserve and increased vulnerability to physiologic stressors, frailty has been associated with prevalent cardiovascular disease (CVD). In prospective studies of older adults, frailty is independently associated with higher risks of comorbidity, disability, hospitalization, and all-cause mortality.[11–18] After acute CVD events and CVD interventions, the presence of frailty has been associated with worse outcomes and a higher likelihood of adverse consequences.[18–22] Although the risk of both cardiovascular and noncardiovascular mortality increases with frailty status, 65% of the deaths among older frail men are the result of noncardiovascular causes.[23] As a consequence, given a relatively high prevalence of noncardiovascular deaths, ICD therapy may have a lower survival benefit among frail individuals.

This study had three objectives: to assess the prevalence and clinical correlates of frailty among men enrolled in a community-based ICD clinic; to examine prospectively the association between frailty and appropriate ICD shocks, hospitalizations, and death; and to evaluate the feasibility of performing a frailty assessment without affecting the flow of a routine cardiac device clinic visit.

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