BACKGROUND: Frailty, marked by increased vulnerability and reduced physiological reserve, is common in end-stage heart failure patients. Continuous flow left ventricular assist devices (LVADs) have improved outcomes, but the impact of frailty on these outcomes is unclear. This systematic review and meta-analysis investigate the effect of frailty on clinical outcomes in patients undergoing LVAD therapy. METHODS: Following PRISMA guidelines, we searched PubMed, Cochrane, EMBASE, MEDLINE, and Google Scholar up to September 2023 for studies comparing frail and non-frail patients undergoing LVAD implantation. Data on mortality, hospital length of stay, intubation duration, bleeding, infection, and readmission rates were extracted and analyzed using the Mantel-Haenszel random-effects model, with heterogeneity assessed by the I2 statistic. RESULTS: Fifteen studies involving 3458 patients were included. Frailty was significantly associated with higher long-term mortality (OR: 2.12
95% CI: 1.17-3.83
p = 0.01), but not with short-term mortality (OR: 1.61
95% CI: 0.71-3.65
p = 0.26), hospital length of stay (MD: 1.93
95% CI: -9.83 to 13.68
p = 0.75), or intubation duration (MD: 34.28
95% CI: -1.15-69.71
p = 0.06). No significant differences were found in bleeding (OR: 1.76
95% CI: 0.76-4.10
p = 0.19), infection (OR: 0.44
95% CI: 0.11-1.84
p = 0.26), or readmission rates (OR: 1.07
95% CI: 0.78-1.46
p = 0.68). CONCLUSION: Frail patients with LVADs have higher long-term mortality but similar short-term outcomes, hospital stays, intubation times, bleeding, infection, and readmission rates compared to non-frail patients. These findings highlight the need for tailored strategies to improve outcomes in frail LVAD patients and suggest further research on frailty interventions.