Frailty Predicts Clinical Outcomes After Left Atrial Appendage Closure: A Systematic Review and Meta-analysis

Abstract

Frailty is increasingly recognized in older adults referred for percutaneous Left Atrial Appendage Closure (LAAC), yet its prognostic implications remain incompletely defined. We evaluated whether frailty is associated with worse clinical outcomes after LAAC. PubMed, ScienceDirect, Scopus, and Cochrane Library were searched from inception through April 2026. Observational studies evaluating adults undergoing LAAC and reporting outcomes by frailty status were eligible. Three reviewers independently performed study selection and data extraction. Risk of bias was assessed with the Newcastle-Ottawa Scale, and pooled estimates were synthesized using inverse-variance models according to heterogeneity. Six observational study reports were included, comprising five retrospective datasets and one prospective cohort. Across reports, 201,411 procedure records were represented, although one Medicare cohort contributed to two related publications. Frailty prevalence ranged from 5.8% to 49.3%. Frailty was associated with higher all-cause mortality (Odds Ratio [OR] 2.60, 95% Confidence Interval [CI] 1.92-3.51), major adverse cardiovascular events (OR 1.82, 95% CI 1.24-2.68), rehospitalization (OR 1.51, 95% CI 1.17-1.94), ischemic stroke (OR 1.81, 95% CI 1.10-2.96), bleeding events (OR 1.23, 95% CI 1.02-1.49), and vascular or procedure-related complications (OR 1.43, 95% CI 1.23-1.67). Transient ischemic attack and pericardial complications were not statistically significant. Frailty identifies LAAC candidates at higher early and intermediate-term risk despite high procedural success. Because the evidence is mainly observational and heterogeneous, frailty assessment should refine counseling, optimization, and shared decision-making rather than serve as a stand-alone reason to withhold LAAC.