Prevention and Reversal of Frailty in Heart Failure　― A Systematic Review ―

Abstract

Background: Frailty is prevalent in patients with heart failure (HF) and associated with increased morbidity and mortality. Hence, there has been increased interest in the reversibility of frailty following treatment with medication or surgery. This systematic review aimed to assess the reversibility of frailty in patients with HF before and after surgical interventions aimed at treating the underlying cause of HF. It also aimed to assess the efficacy of cardiac rehabilitation and prehabilitation in reversing or preventing frailty in patients with HF. Methods and Results:Searches of PubMed, MEDLINE and Academic Search Ultimate identified studies with HF patients undergoing interventions to reverse frailty. Titles, abstracts and full texts were screened for eligibility based on the PRISMA guidelines and using predefined inclusion/exclusion criteria in relation to participants, intervention, control, outcome and study design. In total, 14 studies were included: 3 assessed the effect of surgery, 7 assessed the effect of rehabilitation programs, 2 assessed the effect of a prehabilitation program and 2 assessed the effect of program interruptions on HF patients.Conclusions: Overall, it was found that frailty is at least partially reversible and potentially preventable in patients with HF. Interruption of rehabilitation programs resulted in deterioration of the frailty status. Future research should focus on the role of prehabilitation in mitigating frailty prior to surgical intervention.

Web-Based Questionnaire Survey on Heart Failure in Elderly Patients Using Outpatient Rehabilitation ― Actual Conditions of Cardiac Rehabilitation in Long-Term Care Insurance Systems ―

“…Because 80% of all patients were over 80 years of age, we believe that this was to prevent frailly. 25 , 26 “Salt intake” and “smoking cessation” as lifestyle guidance for patients with HF were also frequently selected. However, the selection of “explanation of the need to visit a medical institution” and “guidance on the prevention of infectious diseases” was significantly lower in accepting facilities (P<0.05).…”

Prehabilitation of Cardiac Surgical Patients, Part 1: Anemia, Diabetes Mellitus, Obesity, Sleep Apnea, and Cardiac Rehabilitation

“…The PEARL study demonstrated improvements in a physical performance battery after cardiac rehab; despite reporting no adverse outcomes, improvement in death and hospitalization was not measured. 109 Other trials have demonstrated a reversal of some frailty in heart failure patients, 110,111 which may translate into reducing poor outcomes indirectly. Others have shown improvement in mental health after these programs.…”

Peri‐procedural management of transcatheter mitral valve replacement in patients with heart failure

“…As has been learnt from the TEER experience, 6 symptoms of heart failure and frailty are commonplace in TMVR cohorts, and careful optimization of guideline‐directed medical therapy should be prioritized for all patients before intervention 21,22 . This includes electrophysiology assessment and/or cardiac resynchronization device therapy where appropriate, correction of iron deficiency anaemia and physical conditioning, termed prehabilitation 23 .…”

“…This includes electrophysiology assessment and/or cardiac resynchronization device therapy where appropriate, correction of iron deficiency anaemia and physical conditioning, termed prehabilitation 23 . Two studies have reported on the benefits of cardiac prehabilitation prior to surgery, although none prior to TMVR 22,24,25 . A home‐based exercise programme whilst awaiting TMVR should be considered within the limitations of the patient's pre‐operative functional class 24 …”