Prognostic effects of cardiac rehabilitation in heart failure patients classified according to physical frailty: A propensity score-matched analysis of a nationwide prospective cohort study

Takuji Adachi; Naoki Iritani; Kuniyasu Kamiya; Kotaro Iwatsu; Kenta Kamisaka; Yuki Iida; Sumio Yamada; FLAGSHIP collaborators

doi:10.1016/j.ijcrp.2023.200177

Prognostic effects of cardiac rehabilitation in heart failure patients classified according to physical frailty: A propensity score-matched analysis of a nationwide prospective cohort study

Int J Cardiol Cardiovasc Risk Prev. 2023 Mar 6:17:200177. doi: 10.1016/j.ijcrp.2023.200177. eCollection 2023 Jun.

Authors

Takuji Adachi¹, Naoki Iritani², Kuniyasu Kamiya³, Kotaro Iwatsu⁴, Kenta Kamisaka⁵, Yuki Iida⁶, Sumio Yamada¹; FLAGSHIP collaborators

Affiliations

¹ Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan.
² Department of Cardiac Rehabilitation, Toyohashi Heart Center, Toyohashi, Japan.
³ Department of Hygiene & Public Health, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
⁴ Department of Rehabilitation, Hirakata Kohsai Hospital, Hirakata, Japan.
⁵ Department of Rehabilitation, Tazuke Kofukai Medical Institute Kitano Hospital, Osaka, Japan.
⁶ Department of Physical Therapy, Toyohashi SOZO University, Toyohashi, Japan.

Abstract

Background: Research regarding cardiac rehabilitation (CR) in the prognosis of heart failure (HF) patients and frailty remains lacking. Here, the effects of CR on the 2-year prognosis of HF patients were examined according to their frailty status.

Methods: This multicenter prospective cohort study enrolled patients hospitalized for HF. Patients who underwent ≥1 session per 2 weeks of CR within 3 months after discharge were categorized in the CR group. Patients were divided in a non-frailty (≤8 points) and physical frailty group (≥9 points) based on their FLAGSHIP frailty score. The score is based on HF prognosis, with a higher score indicating worsened physical frailty. A propensity score-matched analysis was performed to compare survival rates between the two groups according to their physical frailty status. Endpoints included HF re-hospitalization and all-cause mortality during a 2-year follow-up period.

Results: Of 2697 patients included in the analysis, 285 and 95 matched pairs were distributed in the non-frailty and physical frailty groups, respectively, after propensity-score matching. CR was associated with lower incidence of HF rehospitalization in both non-frailty (hazard ratio 0.65; 95% confidence interval 0.44-0.96; p = 0.032) and physical frailty (0.54; 0.32-0.90; p = 0.019) groups. CR was not associated with all-cause mortality in either group (log-rank test, p > 0.05).

Conclusion: These findings suggest the effects of CR on reduced HF rehospitalization, regardless of physical frailty status.

Keywords: Cardiac rehabilitation; Heart failure; Physical frailty.