Impact of a cardiovascular rehabilitation program on frailty indicators in elderly patients with heart disease

Abstract

Funding Acknowledgements Type of funding sources: Private hospital(s). Main funding source(s): Hospital Cardio Pulmonar INTRODUCTION Frailty has been considered an important predictor of morbidity and mortality in elderly patients with cardiovascular disease. Cardiovascular Rehabilitation (CVR) has a direct and unequivocal effect on improving functional capacity in patients with heart disease, however, the effect of CVR on frailty indicators has not yet been well established. PURPOSE: To evaluate the association of the CVR program with frailty indicators in elderly patients with heart disease referred to a cardiovascular rehabilitation program and to identify possible predictors of improvement in frailty in this population. METHODS: Retrospective cohort with patients over 65 years old referred to an CVR program in Salvador-BA, Brazil from August / 2017 to March / 2020. Frailty was assessed using the Edmonton Frail Scale (EFS) at baseline and at least 3 months after the start of the program. Student"s t and Chi-square tests were used to compare continuous and categorical variables, respectively, logistic regression to analyze independent predictors of improvement in frailty and p <0.05 adopted as statistically significant. RESULTS: 51 patients were included, with a mean age of 75 ± 6 years, 65% men, 39 (77%) with coronary artery disease, 23 (50%) with heart failure, 21 (41%) with diabetes, 34 (67%) with hypertension and 41 (80%) dyslipidemia. According to the American Heart Association (AHA) risk stratification for exercise, 21 (49%) were risk B and 22 (51%) risk C. Regarding functional capacity, 12 (31%) were class I, 21 (41%) class II, 5 (13%) class III and 1 (3%) class IV according to the New York Heart Association (NYHA). The average initial ejection fraction was 53 ± 16%. The mean time between the two assessments was 5 ± 2 months and the improvement observed in maximum oxygen consumption (VO2 max) was from 15 ± 4 to 16 ± 4 mL.Kg-1.min-1 (p = 0.001). Regarding frailty, there was an improvement from 5.4 ± 2.0 to 4.8 ± 1.9 in the average of the EFS score (p = 0.034), with 25 patients (49%) being considered responders. This group was predominantly formed by men, non-diabetics, using statins, at risk B (AHA) and with a higher score on the quality of life score and on the EFS. However, in the multivariate analysis, only the highest score on the EFS (OR 1.8 CI 95% 1.06-3.3; p <0.05) and the lowest risk on the AHA scale (OR 0.18 CI 95% 0.03-0.97; p <0.05) remained as independent predictors of response. CONCLUSIONS: There was a significant improvement in the frailty of elderly patients referred for CVR, the higher the baseline frailty score, the greater the chance of response.

Role of frailty on cardiac rehabilitation in hospitalized older patients

“…After 3 months, the intervention group showed great improvement in physical frailty, assessed through the primary outcome (SPPB); a modified frailty phenotype was also employed as secondary outcome to test for improvement of global status, revealing the frail subgroup to benefit more from the CR program than the non-frail or prefrail ones [ 30 ]. A retrospective analysis on 51 Brazilian patients aged ≥ 65 years undergoing CR program revealed a significant improvement in the frailty status of participants, assessed through the Edmonton Frail Scale (EFS) at the beginning and 3 months after intervention, with the frailer ones experiencing the best improvement of global status [ 31 ]. Kehler and collaborators performed a secondary analysis on 4004 CVD adults referred to CR clinic for 12-week program, measuring frailty at baseline and at the end of intervention through a 25-item FI; the authors reported a significant reduction in frailty status at the end of the rehabilitation, especially in patients with severe frailty.…”