Influence of Frailty on Cardiac Rehabilitation Goal Achievement

by Evan MacEachern, Dr. Scott Kehler

Abstract: Heart disease patients are living with more health problems. Multiple health problems can be expressed as frailty. Frailty is important in cardiac rehabilitation (CR); however, it is uncertain whether patient frailty affects CR goal achievement. CR patients underwent a frailty assessment upon admission to the program. A 25-item frailty index (FI) including health problems related to age determined patient frailty status (scores range from 0-1; higher scores indicate higher frailty). Patients were categorized by admission frailty score (<0.20, 0.20-0.30, 0.30-0.40, >0.40). CR goals (e.g., improve fitness) were determined by patients. Logistic regression analyses adjusted for age, sex, education, and diagnosis. Secondary analysis investigated if obtaining a clinically significant change in frailty score (a 0.03 improvement in the FI) from admission to graduation improved CR goal achievement. Of the 759 participants (age 59.5±9.8, 24% female), 607 (80%) patients achieved a CR goal at graduation. Lower levels of frailty were associated with CR goal achievement (FI<0.20: OR=4.06[1.83-9.01]; FI 0.20-0.30: OR=2.32[1.35-3.97]; FI 0.30-0.40: OR=1.19[0.764-1.86]; FI>0.40 = Reference). Every 1% increase in FI score revealed 1.2% reduced odds of achieving a CR goal (OR=0.98[0.95-0.98]). Clinical improvements in frailty during CR was not associated with CR goal achievement (OR=1.19[0.76-1.86]). Lower levels of admission frailty were associated with CR goal achievement. Additionally, every 1% increase in admission FI score resulted in 1.2% reduced odds of CR goal achievement. Patients who improved their frailty score during CR were not associated with achieving CR goals.