Impact of frailty on the effectiveness of intervention to reduce adverse outcomes in heart failure

Objective Heart failure (HF) is a leading cause of hospital readmission and mortality, particularly among frail older adults. This study evaluates the impact of physical, cognitive, and social frailty on the effectiveness of a disease management program (DMP) in reducing hospital readmission and mortality in HF. Methods A total of 1,070 HF patients from six Australian hospitals (2014–2017) were included. Frailty was assessed using validated tools: Fried Phenotype (physical frailty), Montreal Cognitive Assessment (MoCA) (cognitive frailty), and Makizako’s questionnaire (social frailty). Patients were stratified into usual care (n=636) or DMP (n=434). Primary and secondary outcomes were all-cause readmission or death at 1-month and 3-month post-discharge. Multivariable logistic regression models adjusted for confounders evaluated associations. Results All three frailty domains independently predicted higher readmission and mortality at 1-month and 3-month follow-ups. Physical frailty increased risk by 1.69 times (95% CI: 1.02–2.80), cognitive frailty by 2.03 times (95% CI: 1.48–2.77), and social frailty by 2.07 times (95% CI: 1.41–3.02). The effectiveness of the DMP was greater for HF patients with either physical or cognitive frailty and appeared to be greatest for those with both physical and cognitive frailty. Presence of social frailty did not modify the effectiveness of the DMP. Conclusion Presence of frailty predicts worse post-discharge outcomes in HF and may determine how HF patients respond to a DMP. Screening for physical and cognitive frailty in HF patients before implementation of a DMP may allow personalized plans to maximize the effects of the DMP.