Abstract Body (Do not enter title and authors here): Background: Frailty is linked to adverse clinical outcomes across various patient and procedural cohorts. Leadless pacing has recently emerged as a promising therapy; however, little is known regarding its utilization and outcomes.
Aim: To assess the association between frailty and hospital outcomes in patients undergoing leadless pacemaker implantation (LPI).
Methods: We conducted a retrospective cohort study using the National Inpatient Sample to identify patients aged at least 18 years who underwent LPI between 2016 and 2020. Patients with a history of cardiac implantable electronic devices or procedures, including ablation, percutaneous coronary intervention, coronary artery bypass surgery, and valvular intervention, were excluded. A total of 21,210 patients were included and divided into three groups based on the Hospital Frailty Risk Score (HFRS): low risk (HFRS <5, n=7540), intermediate risk (HFRS 5-15, n=12010), and high risk (HFRS >15, n=1660). All analyses were performed using R, and the adjusted odds ratio (aOR) was determined using multivariate logistic regression analysis.
Results: Overall, 64.4% of patients were at intermediate or high risk of frailty. The most common comorbidities in the high-risk group were diabetes (40.7%), congestive heart failure (53.3%), renal failure (55.4%), and hypertension (84.0%). Patients at intermediate or high risk of frailty had a higher risk of in-hospital mortality compared to the low-risk group (adjusted odds ratio 5.44 [95% CI, 3.20-9.25] for HFRS 5-15, and 7.07 [95% CI, 3.68-13.58] for HFRS >15). The most common complications were acute kidney injury and bleeding, with aOR of 2.77 [95% CI, 2.39-3.21] in the intermediate group and 5.21 [95% CI, 3.95-6.86] in the high-risk group. The length of hospital stay (16.39 vs. 4.5 days) and discharge to a nursing facility (58.7% vs. 12%) were also higher in the high-risk group compared to the low-risk group..

Conclusion: Frailty is associated with an increased risk of mortality and complications in patients undergoing LPI and can be used for prognostication and informed decision-making with patients.