MacEachern Evan, Quach Jack, Giacomantonio Nicholas, Theou Olga, Hillier Troy, Firth Wanda, Kehler Dustin Scott
School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.
Faculty of Health, Dalhousie University, Halifax, NS, Canada.
Front Cardiovasc Med. 2024 Aug 13;11:1441336. doi: 10.3389/fcvm.2024.1441336. eCollection 2024.
Frailty is common among patients entering cardiac rehabilitation (CR). Frailty is associated with poor health outcomes; however, it is unclear if frailty influences achieving goals in CR.
We report a secondary analysis of participants who were referred to an exercise and education-based CR program from 2005 to 2015. Frailty was measured by a 25-item accumulation of deficits frailty index (FI) ranging from 0 to 1; higher scores indicate higher frailty. Participants were categorized by admission frailty levels (FI scores: < 0.20, 0.20-0.29, 0.30-0.39, > 0.40). CR goals were determined with shared decision-making between CR staff and the patients. We conducted logistic regression analyses to examine the odds of goal attainment by CR completion, adjusting for age, sex, education, marital status, and referring diagnosis. Analyses were performed using baseline frailty as a categorical and continuous outcome, and frailty change as a continuous outcome in separate models.
Of 759 eligible participants (age: 59.5 ± 9.8, 24% female), 607 (80%) participants achieved a CR goal at graduation. CR goals were categorized into similar themes: control or lose weight ( = 381, 50%), improve physical activity behaviour and fitness ( = 228, 30%), and improve cardiovascular profile ( = 150, 20%). Compared to the most severe frailty group (FI >0.40), lower levels of frailty at baseline were associated with achieving a goal at CR completion [FI < 0.20: OR = 4.733 (95% CI: 2.197, 10.194), < .001; FI 0.20-0.29: OR = 2.116 (1.269-3.528), = .004]. Every 1% increase in the FI was associated with a 3.5% reduction in the odds of achieving a CR goal [OR = 0.965 (0.95, 0.979), < .001]. Participants who reduced their frailty by a minimally clinically important difference of at least 0.03 ( = 209, 27.5%) were twice as likely to achieve their CR goal [OR = 2.111 (1.262, 3.532), = .004] than participants who increased their frailty by at least 0.03 ( = 82, 10.8%). Every 1% improvement in the FI from baseline to follow up was associated with a 2.7% increase in the likelihood of CR goal achievement [OR = 1.027 (1.005, 1.048), = .014].
Lower admission frailty was associated with a greater likelihood of achieving CR goals. Frailty improvements were associated with CR goal achievement, highlighting the influence of frailty on goal attainment.
衰弱在进入心脏康复（CR）的患者中很常见。衰弱与健康状况不佳相关；然而，尚不清楚衰弱是否会影响心脏康复目标的实现。
我们报告了对2005年至2015年被转诊至基于运动和教育的心脏康复项目的参与者进行的二次分析。通过一个包含25项内容的累积缺陷衰弱指数（FI）来衡量衰弱程度，范围从0到1；分数越高表明衰弱程度越高。参与者按入院时的衰弱水平进行分类（FI分数：<0.20、0.20 - 0.29、0.30 - 0.39、>0.40）。心脏康复目标是通过心脏康复工作人员与患者共同决策确定的。我们进行了逻辑回归分析，以检验完成心脏康复后实现目标的几率，并对年龄、性别、教育程度、婚姻状况和转诊诊断进行了调整。分析分别以基线衰弱作为分类和连续变量结果，以及以衰弱变化作为连续变量结果在不同模型中进行。
在759名符合条件的参与者中（年龄：59.5±9.8，24%为女性），607名（80%）参与者在毕业时实现了心脏康复目标。心脏康复目标分为类似主题：控制体重或减重（=381，50%）、改善身体活动行为和体能（=228，30%）以及改善心血管状况（=150，20%）。与最严重衰弱组（FI>0.40）相比，基线衰弱水平较低与在完成心脏康复时实现目标相关[FI<0.20：OR = 4.733（95%CI：2.197，10.194），<0.001；FI 0.20 - 0.29：OR = 2.116（1.269 - 3.528），=0.004]。FI每增加1%，实现心脏康复目标的几率就降低3.5%[OR = 0.965（0.95，0.979），<0.001]。衰弱程度至少降低0.03这一最小临床重要差异的参与者（=209，27.5%）实现心脏康复目标的可能性是衰弱程度至少增加0.03的参与者（=82，10.8%）的两倍[OR = 2.111（1.262，3.532），=0.004]。从基线到随访期间FI每改善1%，实现心脏康复目标的可能性就增加2.7%[OR = 1.027（1.005，1.048），=0.014]。
入院时衰弱程度较低与实现心脏康复目标的可能性更大相关。衰弱状况的改善与心脏康复目标的实现相关，突出了衰弱对目标达成的影响。
