<div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" paraid="1496360895" paraeid="{9194f76f-aec7-437d-9116-c075fd947d5c}{10}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">A brief report<span> </span></span><span class="NormalTextRun SCXW67841271 BCX0">indicates</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>that p</span><span class="NormalTextRun SCXW67841271 BCX0">atients undergoing left atrial appendage occlusion (LAAO) are at higher risk of adverse clinical and geriatric outcomes if they are frail.</span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335551550":1,"335551620":1,"335559685":0,"335559737":0,"335559738":0,"335559739":160,"335559740":279}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" paraid="1305955236" paraeid="{9194f76f-aec7-437d-9116-c075fd947d5c}{12}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">Osamah Badwan, MD, of the Cleveland Clinic in Ohio, and colleagues,<span> </span></span><span class="NormalTextRun SCXW67841271 BCX0">reported<span> </span></span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW67841271 BCX0">these</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>data in a manuscript published online in<span> </span></span></span><span class="NormalTextRun SCXW67841271 BCX0"><em>JACC: Advances</em>. </span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" paraid="1676783387" paraeid="{9194f76f-aec7-437d-9116-c075fd947d5c}{14}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">Patients with atrial fibrillation (AF) often undergo LAAO to prevent stroke when they are unable to take blood thinners long-term. Older,<span> </span></span><span class="NormalTextRun SCXW67841271 BCX0">frail patients may have more risks associated with LAAO, though this is under-investigated.</span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" paraid="334811194" paraeid="{9194f76f-aec7-437d-9116-c075fd947d5c}{16}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">Investigators in this present study examined how frailty severity (using the modified frailty index [MFI-5])<span> </span></span><span class="NormalTextRun SCXW67841271 BCX0">influences long-term outcomes in patients undergoing LAAO.</span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" paraid="912405029" paraeid="{9194f76f-aec7-437d-9116-c075fd947d5c}{18}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">Data were collected retrospectively from the<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW67841271 BCX0">TriNetX</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>Research Network between 2015 and 2024. Participants were included if they had non-valvular AF and underwent percutaneous LAAO. If patients had rheumatic mitral stenosis or</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>mechanical prosthetic heart valves, they were excluded from the study.</span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" paraid="465681523" paraeid="{9194f76f-aec7-437d-9116-c075fd947d5c}{20}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">The MFI-5 includes hypertension, type II diabetes, chronic obstructive pulmonary disease, congestive heart failure (HF</span><span class="NormalTextRun SCXW67841271 BCX0">)</span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW67841271 BCX0"><span> </span>and</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>non</span><span class="NormalTextRun SCXW67841271 BCX0">-</span><span class="NormalTextRun SCXW67841271 BCX0">independent functional status.</span><span> </span><span class="NormalTextRun SCXW67841271 BCX0">If patients scored MFI-0, they were considered robust, followed by MFI-2 as prefrail and MFI-5 as frail.</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>Prefrail patients were also<span> </span></span><span class="NormalTextRun SCXW67841271 BCX0">identified</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>if they had MFI-related como</span><span class="NormalTextRun SCXW67841271 BCX0">rbidities.</span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" paraid="1140316522" paraeid="{9194f76f-aec7-437d-9116-c075fd947d5c}{22}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">Age, sex, race, chronic kidney disease, HF, atherosclerotic heart disease, prior stroke, tobacco use, body mass index (BMI) and estimated glomerular filtration rate were considered covaria</span><span class="NormalTextRun SCXW67841271 BCX0">tes</span><span class="NormalTextRun SCXW67841271 BCX0">.</span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" paraid="1325055032" paraeid="{9194f76f-aec7-437d-9116-c075fd947d5c}{24}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">The groups were propensity-score<span> </span></span><span class="NormalTextRun SCXW67841271 BCX0">matched,</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>and the mean age of the participants overall<span> </span></span><span class="NormalTextRun SCXW67841271 BCX0">was 77 years.</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>Most participants were White, and 42% to 46% were women across all groups.<span> </span></span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" lang="EN-US" paraid="586720166" paraeid="{ce4dc982-fa20-409a-b68d-045b0373b43d}{92}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">Results<span> </span></span><span class="NormalTextRun SCXW67841271 BCX0">demonstrated</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>that the higher the frailty, the greater the risk for adverse outcomes. All-cause death rates were higher in the prefrail participants (11.3%) versus the robust patients (4.5%; hazard ratio [HR]=</span><span class="NormalTextRun SCXW67841271 BCX0">1.96; 95% confidence interval [CI]=1.45-2.63). Patients in the frail category had the highest all-cause mortality<span> </span></span><span class="NormalTextRun SCXW67841271 BCX0">rat</span><span class="NormalTextRun SCXW67841271 BCX0">es (</span><span class="NormalTextRun SCXW67841271 BCX0">35.2%; HR=9.09; 95% CI=5.56-14.29).</span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" lang="EN-US" paraid="317031074" paraeid="{bb3c5b4e-bf15-4805-b330-339809246a38}{168}"><span class="NormalTextRun SCXW67841271 BCX0">Comparing prefrail and frail patients, frail patients had a higher risk of death (13.5% vs 33.6%).</span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" lang="EN-US" paraid="794770128" paraeid="{eddaf067-ed6d-49f7-b775-9fae99c6f074}{140}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">Patients</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>who were prefrail had a higher risk of stroke (11.3%) versus robust patients (4.4%). Frail patients had an even higher risk of stroke than the two other groups (18.0%).<span> </span></span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" lang="EN-US" paraid="603034078" paraeid="{c7dd6916-ad82-4b89-b5f5-ad0eb08d4247}{142}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">Additionally, patients who were frail or prefrail</span><span class="NormalTextRun SCXW67841271 BCX0">, compared with robust patients,</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>had higher risks of major bleeding</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>and</span><span> </span><span class="NormalTextRun SCXW67841271 BCX0">acute coronary syndrome (ACS).</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>Renal failure and intracranial hemorrhage rates were similar across groups or statistically insignificant.</span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" lang="EN-US" paraid="724157441" paraeid="{8a1930ef-abb3-43f4-8d6d-1f00ddb0c20a}{232}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">Patients were more likely to have geriatric syndrome burden if they were higher in frailty versus robust patients, including delirium, depression, cognitive impairment,<span> </span></span><span class="NormalTextRun SCXW67841271 BCX0">incontinence</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>and</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>malnutrition.</span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" lang="EN-US" paraid="1752906073" paraeid="{da80ca3b-8e66-4101-a293-30bbdb48a710}{175}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">The associations between frailty and poor outcomes worsened as participants aged. Significant increases in morbidity were seen in patients over 75 years old. The investigators noted that this<span> </span></span><span class="NormalTextRun SCXW67841271 BCX0">component</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>of the analysis was exploratory because interaction testing was not available in<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW67841271 BCX0">TriNex</span><span class="NormalTextRun SCXW67841271 BCX0">.</span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" lang="EN-US" paraid="2057696619" paraeid="{d01b5f2e-63da-4cd4-9dcb-2d7f1097b845}{183}"><span class="NormalTextRun SCXW67841271 BCX0">“In this large real-world cohort of patients undergoing percutaneous LAAO, increasing frailty burden as quantified by the MFI-5 was strongly associated with adverse long-term clinical and geriatric outcomes,” the researchers concluded.</span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" lang="EN-US" paraid="1870832104" paraeid="{6b3e89c6-e0db-4322-9e52-4a3f246ebf0c}{162}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">“Importantly, these associations were<span> </span></span><span class="NormalTextRun SCXW67841271 BCX0">evident</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>not only among frail patients, but also in those with intermediate frailty, underscoring that frailty exists along a continuum rather than as a binary state.”</span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" lang="EN-US" paraid="1323226473" paraeid="{6b3e89c6-e0db-4322-9e52-4a3f246ebf0c}{205}"><strong><span class="NormalTextRun SCXW67841271 BCX0">Source:</span></strong><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" lang="EN-US" paraid="619285981" paraeid="{42093288-f45d-4ffc-9b00-fa4eb0439d8a}{19}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">Badwan O,<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW67841271 BCX0">Tabaja</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>C,<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW67841271 BCX0">Motairek</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>I, et al. Frailty<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW67841271 BCX0">severeity</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>outcomes after left atrial appendage occlusion.<span> </span></span></span><span class="NormalTextRun SCXW67841271 BCX0"><em>JACC Adv</em>.</span><span class="NormalTextRun SCXW67841271 BCX0"><span> </span>2026 June 30 (Article in Press).</span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW67841271 BCX0"> <p class="Paragraph SCXW67841271 BCX0" lang="EN-US" paraid="1257212616" paraeid="{df6c96fb-6a90-44ae-b169-c8cc722be236}{214}"><strong><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun MacChromeBold SCXW67841271 BCX0"><span class="NormalTextRun SCXW67841271 BCX0">Image Credit: </span><span class="NormalTextRun SpellingErrorV2Themed SCXW67841271 BCX0">Evrymmnt</span><span class="NormalTextRun SCXW67841271 BCX0"> – stock.adobe.com</span></span><span class="EOP Selected SCXW67841271 BCX0" data-ccp-props="{}"> </span></strong></p> </div>