Abstract
Frailty and pre-frailty affect over half of patients with heart failure (HF) and are linked to less favorable outcomes, independent of age and New York Heart Association (NYHA) functional class. Pre-frailty, a transitional and potentially reversible state, is more prevalent than overt frailty but remains less studied. Cardiopulmonary exercise testing (CPET) is the gold standard for assessing functional capacity (VO2peak) and prognosis in HF, but the relationship between pre-frailty and CPET metrics remains unclear. PURPOSE: Determine whether pre-frailty status is independently associated with lower percent predicted cardiorespiratory fitness (%VO2peak) among individuals with HF compared to those classified as robust. METHODS: In a prospective, cross-sectional cohort, HF patients referred for a CPET completed a Modified Fried Frailty Test and were classified as robust (score = 0) or pre-frail (score = 1–2). Left ventricular ejection fraction (LVEF) was obtained from electronic medical records. The Wasserman equation was used to estimate %VO2peak. Multivariable linear regression was used to assess whether pre-frailty status was independently associated with %VO2peak, after adjusting for LVEF. RESULTS: One hundred and seven pre-frail (81 males) and 56 robust (41 males) participants who completed a treadmill CPET with a respiratory exchange ratio (RER) ≥1.05 were included for analysis. There were no significant differences between groups in age (61.8 ± 12.3 vs. 58.3 ± 11.1 years), BMI (28.3 ± 5.4 vs 28.2 ± 5.7kg/m2), NYHA Class II-III status (76% vs. 61%), or prevalence of HF with reduced ejection fraction (60% vs. 53%). However, pre-frail participants had significantly lower VO2peak (17.8 vs. 20.6 mL/kg/min, p = 0.01). No differences were seen in VE/VCO2 nadir or RER. Pre-frailty was independently associated with lower %VO2peak (β = -7.9, 95% CI [–13.82, –1.94] p = 0.01) and higher LVEF (β = 0.51 per %, 95% CI [0.32, 0.70], p < 0.001). CONCLUSION: Pre-frailty is independently associated with reduced %VO2peak in HF patients, even after adjusting for key clinical factors, highlighting the importance of frailty assessment in this population.
Recommended Citation
Hoehing, Kellie N.; Chui, Alexander; Goldsmith, Rochelle; Garber, Carol FACSM; and Rahman, Afsana
(2025)
"Pre-frailty is Associated with Reduced Percent-Predicted Cardiorespiratory Fitness in Patients with Heart Failure,"
International Journal of Exercise Science: Conference Proceedings: Vol. 15:
Iss.
7, Article 21.
Available at:
https://digitalcommons.wku.edu/ijesab/vol15/iss7/21