Screening for Frailty to Maximise the Effectiveness of Intervention to Reduce Readmission in Heart Failure

Aims
Frailty is highly prevalent and may predict outcomes in patients with heart failure (HF). This study sought to determine whether the presence of multiple frailty domains may impact the effectiveness of a HF disease management program (DMP) to reduce readmissions.
Methods
This study included a total of 1070 consecutive HF patients (aged 73±13 years, 59% male) recruited from hospitals in five Australian states. Primary outcomes were readmission or death at 1 and 3-months. Physical, social, and cognitive frailty were assessed by the Fried phenotype, Makizako’s 5 items, and Montreal Cognitive Assessment, respectively. Main components of the nurse-led DMP included education, home visit, exercise, and early clinical review within 7 days post-discharge.
Results
Physical, social, and cognitive frailty were identified in 67%, 57%, and 75% of patients, respectively. Readmission or death at 3-months was associated with the number of co-existing frailty domains, from 34% (0 domain, n=99), 40% (1 domain, n=270), 48% (2 domains, n=360) to 61% (3 domains, n=341). While the effects of DMP on readmission or death did not differ by the presence of social frailty, patients with physical and/or cognitive frailty appeared to benefit more from the DMP than those without both frailty domains (Figure).
Conclusions
Frailty is highly prevalent among patients hospitalised with HF and may determine how patients respond to a DMP. Targeting intervention at patients with physical and cognitive frailty may maximise the effectiveness of a DMP to reduce post-discharge adverse outcomes.