Implications of Frailty among Men with Implantable Cardioverter Defibrillators.

OBJECTIVES: Frailty is associated with adverse outcomes, but little is known of the impact of frailty on patients with implantable cardioverter defibrillators (ICDs). This study sought to determine the prevalence of frailty, based on quantitative assessment, and assessed its potential impact on outcomes among community-dwelling men with ICDs. METHODS: A total of 124 ICD-treated men presenting for a routine device clinic appointment between May and October 2016 underwent frailty assessment consisting of three components: shrinking (weight loss ≥5% during the past year), weakness (inability to rise from a chair without using their arms), and self-reported poor energy level. Patients who had no components were considered robust, those with 1 component were intermediate stage, and those with ≥2 components were deemed frail. RESULTS: Mean age was 70.4 (±9.7) years. Of the 124 men, 31 (25%) were considered to be frail, 65 (52%) were intermediate, and 28 (23%) were robust. Frail men were older and were more likely to have symptomatic heart failure, chronic kidney disease, and hypertension (P < 0.05 for all) compared with nonfrail men. During a follow-up of 16 months, frail men were significantly more likely to die compared with nonfrail men (29% vs 5.4%, P < 0.0003). The incidence of appropriate ICD shocks (16.1% vs 6.5%) or hospitalizations (38.7% vs 23.7%) tended to be higher among frail versus nonfrail patients, but neither reached statistical significance (P = 0.10). CONCLUSIONS: Almost one-fourth of men with ICD are frail. Almost one-third of frail ICD patients died within 16 months. It may be useful to assess frailty in patients with ICD.

Sleep-disordered breathing and daytime cardiac conduction abnormalities on 12-lead electrocardiogram in community-dwelling older men.

PURPOSE: Nocturnal cardiac conduction abnormalities are commonly observed in patients with sleep-disordered breathing (SDB). However, few population-based studies have examined the association between SDB and daytime cardiac conduction abnormalities. METHODS: We examined a random sample of 471 community-dwelling men, aged ≥67 years, enrolled in the multi-center Outcomes of Sleep Disorders in Older Men (MrOS Sleep) study. SDB severity was categorized using percent of total sleep time with oxygen saturation <90 % (%TST < 90) and apnea hypopnea index (AHI). Cardiac conduction parameters were assessed by resting 12-lead electrocardiography (ECG). All analyses were adjusted for age, site, ß-blocker use, coronary heart disease, calcium channel blocker use, and use of antiarrhythmic medications. RESULTS: Mean age was 77 ± 6 years, median %TST < 90 was 0.7 (IQR 0.00-3.40), and median AHI was 7.06 (IQR 2.55-15.32). Men with greater nocturnal hypoxemia (%TST < 90 ≥ 3.5 %) compared with those without hypoxemia (%TST < 90 < 1.0 %) had a lower odds of bradycardia (OR 0.55 [0.32-0.94]) and right bundle branch block (RBBB) (OR 0.24 [0.08-0.75]) but a higher odds of ventricular paced rhythm (OR 4.42 [1.29-15.19]). Heart rate (HR) increased in a graded manner with increasing %TST < 90 (p-trend 0.01) and increasing AHI (p-trend 0.006), but these gradients were small in absolute magnitude. There were no associations of SDB measures with other ECG conduction parameters. CONCLUSIONS: Greater nocturnal hypoxemia in older men was associated with a lower prevalence of daytime sinus bradycardia and RBBB, a higher prevalence of ventricular paced rhythm, and higher resting HR.