Obesity and frailty independently predict adverse outcomes after HeartMate 3 implantation

A pooled analysis of 2,200 recipients from the MOMENTUM 3 trial and Continued Access Protocol examined obesity, frailty and outcomes after HeartMate 3 implantation. Adjusted analyses linked both obesity and frailty to higher risks of adverse outcomes, while frailty improved by six months in many affected patients.

Obesity was associated with higher adjusted mortality risk.
Frailty independently predicted adverse outcomes after implantation.
Frailty improved in 75.9% of frail-obese patients by six months.
Combined obesity and frailty conveyed the highest absolute risk.

This pooled analysis included 2,200 recipients of a fully magnetically levitated HeartMate 3 left ventricular assist device (LVAD) from the MOMENTUM 3 pivotal trial and Continued Access Protocol. Obesity was defined as a body mass index of at least 30 kg/m²; frailty was assessed using a 40-item cumulative-deficit index. The primary endpoint was survival to transplant, recovery or 24 months of support without disabling stroke or pump-replacement reoperation.

At two years, unadjusted primary-endpoint rates were similar in obese and non-obese recipients (75.1% vs 77.1%). After adjustment, obesity was associated with higher risk of the primary endpoint (hazard ratio [HR] 1.30, 95% CI 1.07–1.58) and all-cause mortality (HR 1.35, 95% CI 1.10–1.67). Frailty was present in 67.3% of obese recipients assessed and was independently associated with the primary endpoint (HR 1.51, 95% CI 1.09–2.10). Obesity and frailty had additive, not statistically synergistic, effects; patients with both had the highest absolute risk.

Frailty improved by at least one severity class within six months in 75.9% of frail-obese patients, and improvement was associated with better survival (adjusted HR 0.14, 95% CI 0.07–0.26). These pooled analyses show associations, not proof that changing frailty alters outcomes. The findings support considering frailty alongside BMI in LVAD recipients, while recognizing that frailty may change after implantation.

In practice

For patients receiving a HeartMate 3 LVAD, this pooled analysis suggests that BMI alone may not capture risk: obesity and frailty were each associated with worse adjusted outcomes, and recipients with both had the highest absolute risk. Frailty also improved in many affected patients during the first six months, with improvement associated with better survival. These findings support assessing frailty alongside obesity and recognizing that frailty can change after implantation; the analyses are observational and do not establish that interventions to improve frailty cause better survival.

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Source

European Heart Journal: Obesity, frail obesity, and outcomes after durable left ventricular assist device implantation: a pooled analysis of the MOMENTUM 3 trials ↗

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