FRAILTY INTERVENTIONS IN ADULTS WITH HEART FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Frailty is common in patients with Heart Failure [HF] and is closely associated with poorer outcomes. The HF disease processes can accelerate the functional capacity decline experienced by pre-frail and frail patients. Furthermore, frailty contributes to worse repercussions in this chronically ill patient population and holds independent challenges beyond the HF disease process itself. The relationship between frailty and HF is often closely interrelated and can increase patients’ overall morbidity and mortality. Interventions that focus on behavioral, nutritional, and/or cognitive therapy can reduce the morbidity of HF patients and decrease the adverse effects related to inactivity such as dyspnea and functional dependence. Therefore, it is imperative to understand whether addressing frailty in patients living with HF would help mitigate unfavorable outcomes in those patients such as symptom burden, readmission rates, mortality. Objectives: The aim of this systematic review and meta-analysis is to identify the different interventions that are currently in practice worldwide for the treatment of frailty in prefrail and frail adults with HF and assess their effects on mortality, symptom burden, and readmission rates of patients living with HF. The focus will be on interventions such as behavioral therapy, cognitive training, exercise, and nutritional based specific interventions Methods: We included studies comparing the effects of interventions targeting frailty to no such interventions in prefrail and frail adults with HF and a New York Heart Association Functional Class II or III. Outcomes assessed included mortality, symptom burden, and readmission rates. CINAHL, Medline, and EmBase databases were searched for published and peer reviewed articles using the predefined selection criteria. All articles included in the meta-analyses were Randomized Control Trials (RCTs). Study risk of bias were assessed using the Risk of Bias 2 Tool after conducting search and article selection. Hazard Ratios and mean differences were pooled for the meta‐analysis. Overlapping data were consolidated, and only unique data points were used. Results: The search resulted in 3649 records that were identified through database search and grey literature. From these records, 2869 records remained after duplicate screening and were then screened for title and abstract by two independent reviewers. Following title and abstract screening, 37 full text articles were assessed for eligibility and 6 articles were included in the systematic review. Six articles were included for the systematic review, while 4 articles were included for the meta-analysis. To conduct the meta-analysis for Short Physical Performance Battery (SPPB) at 3 months, 2 articles were used with a total of 186 participants, 3 articles were used for 6 Minute Walking Distance (6MWD) at 3 months with a total of 150 participants, and 2 articles were used for 6MWD at 6 months with a total of 123 participants. Using a Minimally Clinically Important Difference (MCID) of >1, the meta-analysis for SPPB found that the mean difference in completing a frailty intervention vs. standard care is 1.31 with a 95% CI of 1.04-1.58, indicating a slight increase in SPPB in heart failure patients. Using an MCID of a change of approximately 30-32 meters, the meta-analysis for 6MWD at 3 months found that the mean difference between completing a frailty intervention vs standard care is 18.04 with a 95% CI of 3.88 - 32.21; indicating that the intervention does not increase 6MWD in heart failure patients at 3 months. The meta-analysis for 6MWD at 6 months found that the mean difference between completing a frailty intervention vs standard care is 7.75 with a 95% CI of -21.52 to 37.01, indicating a little to no difference in 6MWD in heart failure patients at 6 months. Summary of Findings: It is imperative to recognize the close relationship of frailty and HF for healthcare professions to provide better support for the management of HF and to facilitate the development of effective interventions that optimize patient care. Furthermore, by acknowledging effective interventions for this specific population, it will enhance HF treatment plans and maximize patient adherence. Funding: None Registration: The protocol of this study was published on PROSPERO (Registration Number CRD42022260621)