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Background There is limited evidence on the differences in procedural outcomes between sexes after de novo cardiac implantable electronic device implantation (CIED). Furthermore, it is unclear whether any sex-based disparities have changed over the years. Purpose To compare procedural outcomes of de novo CIED implantation between sexes and study the trends of these outcomes over a 11-year period in a nationally representative sample. Methods Using the National Inpatient Sample, all hospitalisations between 2004 and 2014 for de novo CIED implantation were included, stratified by sex. Multivariable logistic regression was performed to 1) examine the association between sex and in-hospital complications of CIED implantation, expressed as odds ratios (OR) with 95% confidence intervals (CI), and 2) analyse trends of in-hospital outcomes by assessing the interaction term between time (years) and sex as covariates. Results Out of 2,815,613 hospitalisations for de novo CIED implantation, 41.9% were performed on women. Women were associated with increased adjusted odds of major adverse cardiovascular events (composite of mortality, thoracic and cardiac complications; OR 1.17 95% CI 1.16, 1.19), procedure-related bleeding (OR 1.13 95% CI 1.12, 1.15), and local complications (thoracic: OR 1.42 95% CI 1.40, 1.44, cardiac: OR 1.44 95% CI 1.38, 1.50). (p Conclusion In a national cohort of CIED implantations we demonstrate that women are at a persistently higher risk of procedure-related adverse events other than mortality compared to men. This trend is concerning and warrants further work on procedural techniques to neutralise these sex disparities. Trends of odds of complications in women Funding Acknowledgement Type of funding source: Private company. Main funding source(s): This work constitutes part of a PhD for MOM that is supported by Medtronic Ltd. Medtronic Ltd. was not involved in the conceptualization, design, conduct, analysis, or interpretation of the current study.

Background Frailty may be an important marker for poor outcomes in percutaneous coronary intervention (PCI) and there is limited literature on outcomes based on frailty from national cohorts. Purpose This study evaluates the prevalence of frailty, changes in frailty over time and outcomes associated with frailty in a national American cohort of patients who underwent PCI. Methods The study included adults who underwent PCI in the National Inpatients Sample between 2004 and 2014. Frailty risk was determined using a validated Hospital Frailty Risk Score (HFRS) using the cutoffs 15 corresponding to low, intermediate and high HFRS. Results There were 7,306,007 PCI admissions in this cohort. A total of 94.58%, 5.39% and 0.03% of admissions were for low HFRS, intermediate HFRS and high HFRS, respectively. The proportion of intermediate or high frailty risk patients increased over time from 1.9% in 2004 to 11.7% in 2014. In-hospital death increased from 1.0% with low HFRS to 13.9% with high HFRS and average length of stay increased from 2.9±3.3 days to 17.1±15.5 days from low to high HFRS. Greater frailty risk was associated with greater average inpatient cost which was $17,743±11,059, $38,824±34,809 and $56,119±49,772 for low, intermediate and high HFRS, respectively. There were increased adverse outcomes with high frailty including greater in-hospital death (OR 9.91 95% CI 7.17–13.71), in-hospital bleeding complications (OR 4.99 95% CI 3.82–6.51), in-hospital vascular complications (OR 3.96 95% CI 3.00–5.23) and in-hospital stroke (OR 10.49 95% CI 8.28–13.29) comparing high to low HFRS. Conclusions More than 1 in 20 patients who undergo PCI have intermediate or high risk of frailty which has significantly increased over time. There are poor outcomes and increased inpatient costs associated with greater frailty. Improvements in education of healthcare workers and increased awareness of frailty could facilitate frailty-tailored care to minimise risk of adverse outcomes and its associated costs. Acknowledgement/Funding Research and Development Department at the Royal Stoke Hospital, Keele University and Biosensors International