Tackling Disruptions to Frailty Interventions: Developing Personalized Interventions Targeted for Older Persons With Cardiac Frailty

Summary

Background: Muscle mass loss and metabolic dysfunction, exacerbated by inactivity and nutritional inadequacies, underpin both cardiovascular disease and frailty in ageing. The investigators' proposal seeks to develop interventions in exercise and diet that are targeted for older adults with cardiac frailty. Methods: The investigators' proposal is a five-year study comprising of first phase (first 2-2.5 years) and second phase (next 2-2.5 years). In the first phase cardiac frail participants (up to N=500) from each healthcare transition (inpatient hospital, step-down community hospital, outpatient clinic/community) will be randomized to receive Intervention Sets or usual care. The second phase will scale up these programs. Three Intervention Sets A, B, and C will be implemented in the outpatient, step-down community hospital, and acute hospital settings. Diet intervention comprises meal sets prepared with nutrients involved in energy metabolism. Exercise training is facilitated by hospital gyms and hospital physiotherapists. Diet and exercise behavior will be monitored using questionnaires, video conferencing and meal photos. Significance: Clinical studies are urgently needed using consistent frailty tools to evaluate the efficacy and promise of frailty interventions, targeted to achieve reversal/retardation of frailty. When scaled up, these approaches will provide high-quality science needed to manage cardiac frailty towards healthier population ageing.

Eligibility

Inclusion Criteria:

* Age ≥ 21 years old
* Outdoor ambulant

Exclusion Criteria:

1. Bed-bound
2. Dementia (Stage 6 onwards)
3. Residing in sheltered or nursing home
4. Cancer (to avoid confounding with cardiac disease sequelae from cancer)
5. Participation in ongoing clinical trials that involve interventional drugs or devices
6. Uncontrolled hypertension (systolic blood pressure ≥160mmHg and/or diastolic blood pressure ≥90mmHg) despite being on treatment for hypertension
7. Low blood pressure (systolic blood pressure \<90mmHg or diastolic blood pressure \<40mmHg)
8. Uncontrolled atrial fibrillation (controlled atrial fibrillation is allowed)
9. Ventricular arrhythmias (such as ventricular tachycardia)
10. Renal failure on dialysis
11. Chronic kidney disease Stage 4 and above
12. Nephrotic syndrome
13. Liver cirrhosis Child's B and above
14. Inflammatory Bowel Disease
15. Severe uncontrolled gout
16. Poorly controlled Diabetes Hba1c ≥9%
17. On warfarin
18. Presence of food allergies (such as shell-fish, prawn)
19. Patient's life expectancy is expected to be less than one year at the time of potential enrolment as assessed by the investigator
20. Nasogastric or parenteral nutrition
21. Hypertrophic cardiomyopathy
22. Cardiac amyloidosis
23. Cardiac sarcoidosis

Conditions2

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