ArticleJACC. Advances2026
Long-Term Impact of Frailty on Outcomes Following Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy.
Article in JACC. Advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThere are limited data on the impact of frailty in patients undergoing alcohol septal ablation (ASA) for the treatment of hypertrophic obstructive cardiomyopathy (HOCM).
objectivesThe objective of the study was to evaluate the impact of frailty on long-term clinical outcomes in patients undergoing ASA for HOCM.
methodsUsing the United States Collaborative Network (2005-2025), we identified patients with HOCM undergoing ASA and stratified them into frail and nonfrail groups based on the Johns Hopkins Adjusted Clinical Group frailty-defining diagnosis. Propensity-score matching (1:1) was applied to adjust for baseline differences in demographics, comorbidities, medications, and labs. Kaplan-Meier analysis and Cox proportional hazards regression were used to estimate HRs using the built-in R-computing software (v3.2 to 3). The primary outcome was all-cause mortality at various follow-ups post-ASA (1-, 3-, 5-, and 10 years).
resultsAmong 39,063 patients undergoing ASA, 2,264 (5.8%) were frail. Post-propensity-score matching, 2,219 patients were matched per group. Frail patients demonstrated higher all-cause mortality at all follow-ups (10-year HR: 1.40; 95% CI: 1.26-1.55; P < 0.001). Frail patients also demonstrated a higher risk of major adverse cardiac and cerebrovascular event (HR: 1.49; 95% CI: 1.30-1.70; P < 0.001), ischemic stroke (HR: 1.57; 95% CI: 1.24-2.00; P < 0.001), heart failure exacerbation (HR: 1.09; 95% CI: 1.01-1.19; P = 0.024), major bleeding (HR: 1.61; 95% CI: 1.38-1.88; P < 0.001), and all-cause readmission (HR: 1.33; 95% CI: 1.24-1.43; P < 0.001) compared with nonfrail patients at 1-year post-ASA. No differences were noted for acute myocardial infarction, sudden cardiac arrest, antiarrhythmic drugs initiation/escalation, or electrical cardioversion.
conclusionsFrail patients undergoing ASA for HOCM exhibit higher risks of long-term mortality and adverse clinical outcomes compared with their nonfrail counterparts.
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