De-frailing intervention for hospitalized cardiovascular patients in the TARGET-EFT randomized clinical trial

Fayeza Ahmad; Rosie Fountotos; Michael Goldfarb; Neetika Bharaj; Haroon Munir; John Marsala; Lawrence G Rudski; Jonathan Afilalo

doi:10.1093/ehjqcco/qcac050

De-frailing intervention for hospitalized cardiovascular patients in the TARGET-EFT randomized clinical trial

Eur Heart J Qual Care Clin Outcomes. 2023 Aug 7;9(5):482-489. doi: 10.1093/ehjqcco/qcac050.

Authors

Fayeza Ahmad^{1

2}, Rosie Fountotos^{1

2}, Michael Goldfarb^{1

3}, Neetika Bharaj^{2

4}, Haroon Munir^{1

2}, John Marsala³, Lawrence G Rudski³, Jonathan Afilalo^{1

2

3}

Affiliations

¹ Division of Experimental Medicine, McGill University, Montreal,QC H4A 3J1,Canada.
² Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, QC H3T 1E2,Canada.
³ Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2,Canada.
⁴ Department of Kinesiology & Physical Education, McGill University, Montreal, QC H2W 1S4, Canada. Institution of research trial: Jewish General Hospital, Montreal, QC H3T 1E2, Canada.

Abstract

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 anaemia, we tested a multicomponent targeted 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) assessed 30 days later. The analysis consisted of 135 patients (mean age of 79.3 years; 54% female) who survived and completed the frailty assessments.Compared with 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.

Conclusion: 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.

One sentence summary: The multicomponent intervention targeted to the deficits of vulnerable older adults hospitalized with acute cardiovascular diseases successfully de-frailed them on a short-term basis, which can have positive implications on their post-discharge health outcomes.

Keywords: cardiology; frailty; geriatrics; intervention; physical performance; randomized clinical trial.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aftercare
Aged
Female
Frailty* / complications
Humans
Male
Patient Discharge
Stroke Volume
Ventricular Function, Left

Grants and funding

CIHR/Canada