Influence of Frailty on Cardiac Rehabilitation: A Harmonized Analysis of Five Cardiac Rehabilitation Databases in Canada and Europe

Cardiovascular disease (CVD) involve problems of the heart or blood vessels. CVDs affect one in three older adults, making it a leading cause of death in Canada. Often, those living with CVD also have other problems which impact their health. People with many health problems can be described as frail. Research has estimated that frailty is present in up to half of patients living with CVD. This is concerning because frailty can worsen the problems of CVD. Cardiac rehabilitation (CR) programs help patients recover from a CVD event such as a heart attack. These programs support patients with exercise, education, and counseling. Research shows that these programs improve quality of life and reduce the risk of dying prematurely. Our research group has shown that many CR patients are frail, and completion of the program reduced their frailty levels. However, we do not know how important frailty and frailty changes can be in the broader context of CR within Canada and in other countries. My work will investigate the role of frailty in CR and determine if reducing frailty levels with CR will reduce worse outcomes and improve health. My study will connect five large databases from Canada and Europe (Sweden, UK, Denmark) to investigate frailty and frailty changes as patients complete a CR program. I will also investigate how changes in frailty affects traditional CVD risk factors (e.g., blood sugar levels, cholesterol). If improving patient frailty can improve the health of patients with CVD, then frailty may need to be routinely assessed in CR programs. Identifying the frailty level of the patients will enable adjustments to CR treatments (e.g., changing intensity of physical activity). This will ensure that that each patient will receive care tailored for their needs. My thesis work findings will also be useful to organizations such as the Canadian Association of Cardiovascular Prevention and Rehabilitation when creating CR guidelines.