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

doi:10.1016/j.jacadv.2026.102767

Heart failure & cardiomyopathies

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

JACC AdvPublished 28 Apr 2026Propensity-score matched cohort study

Main finding · All-cause mortalityResultHazard ratio 1.40 95% CI 1.26–1.55

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Authors' conclusion

Frail patients undergoing ASA for HOCM exhibit higher risks of long-term mortality and adverse clinical outcomes compared with their nonfrail counterparts.

Study context

Population: Patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA), stratified into frail and nonfrail groups by the Johns Hopkins Adjusted Clinical Group frailty-defining diagnosispatients undergoing ASA, 2,264 (5.8%) were frail, 2,219 patients matched per group
Participants: 39,063 patients

Exposure: Frail vs nonfrail patients undergoing ASA
Frailn = 2,219
Nonfrailn = 2,219reference
Outcome: All-cause mortality
Follow-up: 10 years

Methodological detailsUnited States Collaborative Network (2005-2025), Propensity-score matching (1:1)

United States Collaborative Network (2005-2025)
Propensity-score matching (1:1)

Main finding

All-cause mortality

Hazard ratio

1.40

95% CI 1.26–1.55

P < 0.001

Frail vs Nonfrail

HR 1.40 (95% CI 1.26–1.55); P < 0.001

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with frail ←→ Higher risk with frail →	HR (95% CI)	P value
Major adverse cardiac and cerebrovascular event · 1-year post-ASA	0.512	1.49 (1.30–1.70)	P < 0.001
Ischemic stroke · 1-year post-ASA	0.512	1.57 (1.24–2.00)	P < 0.001
Heart failure exacerbation · 1-year post-ASA	0.512	1.09 (1.01–1.19)	P = 0.024
All-cause readmission · 1-year post-ASA	0.512	1.33 (1.24–1.43)	P < 0.001
	0.512Hazard ratio (log scale)

Acute myocardial infarction, sudden cardiac arrest, antiarrhythmic drugs initiation/escalation, electrical cardioversion

No differences were noted

Safety

Outcome	← Lower risk with frail ←→ Higher risk with frail →	HR (95% CI)	P value
Major bleeding · 1-year post-ASA	0.512	1.61 (1.38–1.88)	P < 0.001
	0.512Hazard ratio (log scale)

Original publication

Long-Term Impact of Frailty on Outcomes Following Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy. JACC Adv. Published 28 April 2026. doi:10.1016/j.jacadv.2026.102767

Read the original article ↗PubMed

Summarised from the published abstract; every number is checked against it