JACC Advances · Apr 28, 2026

Long-Term Impact of Frailty on Outcomes Following Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

By Jain H, Patel N, Jain J et al.

BACKGROUND: There are limited data on the impact of frailty in patients undergoing alcohol septal ablation (ASA) for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). OBJECTIVES: The objective of the study was to evaluate the impact of frailty on long-term clinical outcomes in patients undergoing ASA for HOCM. METHODS: Using 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). RESULTS: Among 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. CONCLUSIONS: Frail patients undergoing ASA for HOCM exhibit higher risks of long-term mortality and adverse clinical outcomes compared with their nonfrail counterparts.

doi.org/10.1016/j.jacadv.2026.102767 Open access PubMed 42202378 Populations