Frailty implications for exercise participation and outcomes in patients with heart failure

Background/Objectives Frailty is common in people with heart failure (HF) and associated with poorer outcomes. The aim of this study was to describe the characteristics, exercise participation, and outcomes of frail and not-frail participants enrolled in a randomized trial of exercise training (ET) within a cardiac rehabilitation (CR) program. Design Secondary analysis of EJECTION-HF randomized trial (ACTRN12608000263392). Setting Five HF-specific CR programs in Queensland, Australia. Participants Adults recently hospitalized with HF. Intervention All participated in CR including home exercise prescription and monitoring; half were randomized to center-based ET. Measurements A frailty index (FI) was constructed at randomization and 6-month follow-up. Outcomes included ET attendance, change in 6-min walk distance (6MWD), improved FI (>0.09 units) at 6 months, achieving physical activity (PA) guidelines at 6 months, and 12 month all-cause death or readmission. Results The FI was measured in 256 participants at randomization: 110 (43%) were not-frail (FI 0.2 or less), 119 (46%) were frail (FI >0.2 to 0.39), and 27 (11%) were very frail (FI >= 0.4). Frailty was more common with older age, female gender, decompensated HF, worse HF symptoms, and preserved ejection fraction. ET attendance did not differ by frailty group. Participants who were more frail had lower 6WMD at enrollment, but similar improvement over 6 months. Mean FI improved by 0.03 units at 6 months (95% CI 0.02-0.04, p < 0.001). Participants who were more frail had significantly greater improvements in FI compared with not-frail participants and were often able to achieve PA guidelines, both in intervention and control groups. Neither baseline frailty nor intervention was significantly associated with 12-month death or readmission. Conclusion Frail people with HF participating in CR that includes home and/or center-based ET often achieve PA guidelines, and some may have meaningful reductions in frailty.