Frailty Screening and Management in Cardiac Rehabilitation Programs Across Canada

Frailty and cardiovascular diseases share a strong bidirectional relationship. However, little is known about frailty screening in cardiac rehabilitation (CR) programs in Canada. Thus, the purpose of this study was to examine the current implementation of frailty screening and frailty management strategies in outpatient CR programs across Canada, along with identification of potential barriers to screening and management of frailty to inform future guidelines. A quantitative, cross-sectional survey using a self-administered online questionnaire was conducted to examine Canadian outpatient CR programs that serve adults (aged ≥18 years) and contain an exercise-based component. Of the 173 programs that received the questionnaire, 61 completed it (35.3%). Only four programs (6.6%) used a standardised frailty screening instrument in their initial CR assessment, each using a different instrument and reassessing at different time intervals. Most programs (52.5%) integrated patients deemed frail or at risk of frailty into standard classes. The programs identified barriers to accessing their services such as lack of transportation (77.0%) and health problems/comorbidities (73.8%). Available services that facilitated patients' access to programs included home-based CR (63.9%), web-based/virtual CR (52.5%), and flexible class scheduling (49.2%). Furthermore, the most substantial barriers to management of patients deemed frail were lack of resources to follow up on identified frailty concerns (77.0%), challenges in accommodating patients within the current workload (70.6%), and lack of transportation (68.8%). These findings highlight the need for future research focussed on the identification and piloting of a gold standard instrument for frailty screening across Canadian outpatient CR programs.