Holistic patient-centred intervention to improve outcomes of older people living with FraIlTy and heart failure (FIT-HF): feasibility study

Background

FIT-HF is a multidisciplinary intervention designed to address the complex care needs of older adults with heart failure (HF) and frailty. Co-created with patients, their caregivers and clinicians, FIT-HF is a 12-week programme delivered by a team comprising a HF specialist, geriatrician, HF specialist nurse, pharmacist, dietitian, physiotherapist and occupational therapist. The overarching aim of the programme is to improve health-related quality of life (HRQoL) of older people with HF and frailty.

Purpose

To assess feasibility of recruitment and retention of older patients with HF and frailty in a 12-week programme. Feasibility of administering EuroQoL-5D (EQ-5D), as a patient-reported outcome measure for future effectiveness trial was also explored.

Methods

We recruited 50 older patients (aged ≥ 65) with HF and frailty (Clinical Frailty Scale ≥ 5) from a hospital-based HF clinic between October 2024 – January 2025. Patients initially underwent comprehensive clinical, physical and frailty assessments. Based on information from the assessments, patients’ cases were reviewed by a multidisciplinary team (MDT) to formulate individualised care plans. The care plans, comprising management of HF/comorbidities, medication review, exercise programme, nutritional counselling & environmental/social support, were delivered to patients at a One-Stop Clinic by the MDT. Patients subsequently received 2-weekly follow-up by a keyworker ± MDT, for 12 weeks. At the end of programme, patients returned for post-intervention assessments.

Results

A total of 89 patients were assessed for eligibility; 55 met the inclusion criteria and were approached to participate in the study. Four patients declined (due to poor health and logistical reasons); 51 patients consented to participate (Consent Rate = 93%). Following baseline assessments, one participant was deemed ineligible and excluded from the study; 50 patients were subsequently enrolled in the study.

Of the 50 participants, 47 completed the study (Retention Rate = 94%); 2 participants died and 1 withdrew due to declining health. Median age of participants: 82 (range 65-95) years, 40% female. Fifty-four percent had HF with preserved ejection fraction; median NT-proBNP was 1742.5 ng/L (IQR = 1074 - 4562) (Table 1).

All participants were able to complete the EQ-5D questionnaire (Response Rate = 100%). Preliminary analysis revealed an overall improvement in the HRQoL measure post-intervention. Median EQ-5D index score increased from 0.449 (IQR 0.055 – 0.602) to 0.656 (IQR 0.327-0.728). The EQ visual analogue scale (EQ VAS) also increased from 50 (IQR 35-61) to 70 (IQR 50-80). Figure 1 presents participants’ responses for individual dimensions of EQ-5D and EQ VAS.

Conclusion

Our study supports the feasibility of recruitment and retention of older adults with HF and frailty in a 12-week programme. Early findings indicate FIT-HF programme potentially improves QoL of this patient population.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.