Aims Frailty is disproportionately prevalent in cardiovascular disease patients and exacerbated during hospital admissions, heightening the risk for adverse events and functional decline. Using the Essential Frailty Toolset (EFT) to target physical weakness, cognitive impairment, malnourishment, and anemia, we tested a multicomponent intervention to de-frail older adults with acute cardiovascular conditions during their hospital admission. Methods and Results The TARGET-EFT trial was a single-center randomized clinical trial at the Jewish General Hospital, Montreal, Canada. We compared a multicomponent de-frailing intervention with usual clinical care. Intervention group patients received exercise, cognitive stimulation, protein supplementation, and iron replacement, as required. In this study, the primary outcome was frailty, as assessed by the SPPB score (Short Physical Performance Battery) at discharge, and the secondary outcome was the SARC-F score (Strength, Assistance walking, Rising from chair, Climbing, Falls) 30 days later. The analysis consisted of 135 patient (mean age of 79.3 years; 54% female) who survived and completed the frailty assessments. Compared to control patients, intervention group patients had a 1.52-point superior SPPB score and a 0.74-point superior SARC-F score. Subgroup analysis suggested that patients with low left ventricular ejection fraction may have attenuated benefits, and that patients who underwent invasive cardiac procedures had the greatest benefits from the intervention. Conclusions We achieved our objective of de-frailing older cardiac inpatients on a short-term basis by improving their physical performance and functioning using a pragmatic multicomponent intervention. This could have positive impacts on their clinical outcomes and ability to maintain independent living in the future.

Background With the aging population and rising rates of cardiovascular disease (CVD), cardiologists and cardiac surgeons are encountering a growing number of frail older patients that have complex cardiac and non-cardiac issues. Measuring frailty provides valuable prognostic information to help personalize treatment decisions. However, there is minimal evidence on multicomponent frailty interventions in this setting. The TARGET-EFT (The MulTicomponent Acute Intervention in FRail GEriatric PaTients with cardiovascular disease using the Essential Frailty Toolset) trial aims to target physical and non-physical frailty deficits to improve health-related quality of life and hospital-acquired disability in frail patients hospitalized with CVD. Methods The TARGET-EFT trial is a single-center parallel-group randomized clinical trial in frail and pre-frail older adults ≥65 years admitted to the cardiovascular unit (CVU) at the Jewish General Hospital, Montreal, Quebec. The trial will compare usual inpatient care to a multicomponent intervention targeting physical weakness, cognitive impairment, malnutrition, and anemia. Outcomes of interest in both groups will be assessed at three time points: (1) study enrollment, (2) discharge from the CVU, and (3) 30 days after hospital discharge. Conclusions The overarching goal is to treat patients’ frailty in parallel with their CVD, and in doing so, optimize patient functional losses while in-hospital and shortly thereafter. The results of this trial will inform best practices for patient-centered care in this vulnerable patient group. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s12603-022-1759-y and is accessible for authorized users.

Background Hospitalization for cardiovascular disease (CVD) may be complicated by hospital‐acquired disability (HAD) and subsequently poor health‐related quality of life (HRQOL). While frailty has been shown to be a risk factor, it has yet to be studied as a therapeutic target to improve outcomes. Objectives This trial sought to determine the effects of an in‐hospital multicomponent intervention targeting physical weakness, cognitive impairment, malnutrition, and anemia on patient‐centered outcomes compared to usual care. Methods A single‐center parallel‐group randomized clinical trial was conducted in older patients with acute CVD and evidence of frailty or pre‐frailty as measured by the Essential Frailty Toolset (EFT). Patients were randomized to usual care or a multicomponent intervention. Outcomes were HRQOL (EQ‐5D‐5L score) and disability (Older Americans Resources and Services score) at 30 days post‐discharge and mood disturbances (Hospital Anxiety and Depression Scale) at discharge. Results The trial cohort consisted of 142 patients with a mean age of 79.5 years and 55% females. The primary diagnosis was heart failure in 29%, valvular heart disease in 28%, ischemic heart disease in 14%, arrhythmia in 11%, and other CVDs in 18%. The intervention improved HRQOL scores (coefficient 0.08; 95% CI 0.01, 0.15; p = 0.03) and mood scores (coefficient −1.95; 95% CI −3.82, −0.09; p = 0.04) but not disability scores (coefficient 0.18; 95% CI −1.44, 1.81; p = 0.82). There were no intervention‐related adverse events. Conclusion In frail older patients hospitalized for acute CVDs, an in‐hospital multicomponent intervention targeted to frailty was safe and led to modest yet clinically meaningful improvements in HRQOL and mental well‐being. The downstream impact of these effects on event‐free survival and functional status remains to be evaluated in future research, as does the generalizability to other healthcare systems. Clinical registration number: NCT04291690.