Lead Extraction and Outcomes in Frail Patients With Cardiac Implantable Electronic Device Infections in the United States

INTRODUCTION: Frailty is increasingly recognized as an important determinant of outcomes in cardiovascular disease, yet its population-level impact among patients hospitalized with cardiac implantable electronic device (CIED) infections remains incompletely defined. We examined the prevalence of frailty and its association with clinical outcomes and utilization of transvenous lead removal (TLR) in a contemporary national cohort. METHODS AND RESULTS: We analyzed the National Readmissions Database from 2016-2021 to identify adults hospitalized for CIED infections. Frailty was defined using the Johns Hopkins adjusted clinical groups frailty-defining diagnoses. Of 288,402 patients hospitalized with CIED infections, 25.1% were classified as frail. Frail patients experienced significantly higher in-hospital mortality (10.8% vs. 4.6%), 30-day mortality (9.2% vs. 5.5%), complications, longer length of stay, lower rates of discharge home, and higher 30-day readmissions compared with non-frail patients (all p < 0.01). TLR was performed less frequently in frail patients (10.8% vs. 13.4%; adjusted odds ratio [aOR] 0.80, 95% CI 0.76-0.83). On adjusted analyses, TLR was independently associated with lower in-hospital mortality, 30-day mortality, and 30-day readmissions in both frail and non-frail patients. CONCLUSION: Among patients hospitalized with CIED infections, TLR was independently associated with lower mortality and readmissions in both frail and non-frail patients, despite lower utilization in frail individuals. Frailty was common (25.1%) and independently associated with significantly worse outcomes. These findings highlight important associations between frailty, treatment patterns, and outcomes that warrant prospective evaluation.