Mapping interventions addressing frailty and associated outcomes in people with heart failure: a scoping review

Objectives Frailty in people with heart failure (HF) is a multidimensional state and associated with poor outcomes. Addressing frailty in people with HF has been identified as a priority area to improve outcomes. Yet, related non-pharmacological interventions are rarely described in detail. The aim of this article is to map interventions and associated outcomes addressing frailty in people with HF across the physical-functional, clinical, psycho-cognitive and social dimensions of frailty. Design The scoping review is conducted according to the methodology of the Joanna Briggs Institute. Data sources 12 electronic databases were searched in March 2024. Eligibility criteria Reports involving adults with HF and frailty, encompassing all HF phenotypes and all operational definitions of frailty were considered eligible. All types of sources of evidence were considered. Data extraction and synthesis Reviewers independently extracted data using a data extraction tool specifically developed on the template for intervention description and replication checklist and guide. Results were synthesised and structured according to three research questions. Results We screened 10 890 records and included 155 reports, identifying 44 unique interventions addressing one or more dimensions of frailty. 22 (50%) interventions addressed two or more dimensions of frailty. We found 32 interventions in the physical-functional dimension, which focused on exercise and training in daily living activities. 31 interventions in the clinical dimension addressed HF, comorbidities, medication review, reconciliation and handover and nutrition. Interventions in the psycho-cognitive dimension (n=13) included assessment, psycho-cognitive exercise and/or education, and referrals to specialists. Social dimension interventions (n=10) focused on the assessment, activation or enhancement of social support for people with HF and/or caregivers. Other characteristics of interventions were comprehensiveness, being individualised, using a collaborative approach, integrating digital health technologies or involving caregivers. Several outcomes were reported for physical-functional, clinical and psycho-cognitive dimensions, but none for the social dimension. Conclusions Interventions addressing frailty in people with HF have predominantly been published for the physical-functional and clinical dimensions while psycho-cognitive and social dimensions remain understudied. This review underscores the need for detailed description of future interventions and associated outcomes, and for developing multidimensional interventions. Developing these, thereby allowing replication, will contribute to reaching the objective of improving outcomes in frail people with HF.