Trial reportCirculation2022
Frailty Status Modifies the Efficacy of Exercise Training Among Patients With Chronic Heart Failure and Reduced Ejection Fraction: An Analysis From the HF-ACTION Trial.
Trial report in Circulation, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
43 citing papers in PubMed, 4 syntheses or guidelines pooled it, 89 citations in OpenAlex.
- Efficacy and Safety of Heart Failure Treatment According to Frailty Status: A Systematic Review.Journal of the American Heart Association · 2025Pooled it
- Length of stay and prior heart failure admission in frailty and heart failure: A systematic review and meta-analysis.ESC heart failure · 2025Pooled it
- Assessing Frailty-Specific Treatment Effect in Cardiovascular Disease: A Systematic Review.Drugs & aging · 2024Pooled it
- Frailty as an Effect Modifier in Randomized Controlled Trials: A Systematic Review.Journal of general internal medicine · 2024Pooled it
- Frailty and Recurrent Cardiovascular Events in Patients With Obstructive Sleep Apnoea: The SAVE Study.Journal of cachexia, sarcopenia and muscle · 2026Trial
- Sex Differences in Efficacy of Multidomain Rehabilitation Among Older Adults With Acute HF: The REHAB-HF Trial.JACC. Heart failure · 2025Trial
- Trial
- Frailty, age, and treatment effect of surgical coronary revascularization in ischemic cardiomyopathy: a post hoc analysis of the STICHES trial.GeroScience · 2025Trial
- Efficacy and Safety of Dapagliflozin According to Frailty in Patients With Heart Failure: A Prespecified Analysis of the DELIVER Trial.Circulation · 2022Trial
- Mediators of the effect of exercise-based cardiac rehabilitation on hospitalisation risk in people with coronary heart disease - the CaReMATCH individual participant data meta-analysis.European journal of epidemiology · 2026Article
- Physical rehabilitation for older patients with acute HFpEF (REHAB-HFpEF) trial: Design and rationale.American heart journal · 2026Article
- Association of the Frailty-to-Estimated Cardiorespiratory Fitness Ratio with Prevalent Stroke in Middle-Aged and Older Adults: A Cross-Sectional NHANES Study.Bioengineering (Basel, Switzerland) · 2026Article
- Biological aging mediates and frailty modifies the associations of arterial stiffness with incident probable sarcopenia and sarcopenia: a prospective cohort study of UK biobank.Frontiers in public health · 2026Article
- Multidimensional and Multidisciplinary Management of Heart Failure Patients with Frailty.Cardiac failure review · 2026Review
- Article
- Impact of non-cardiovascular factors on cardiovascular death in acute decompensated heart failure: Enhancing predictive models with frailty and comorbid constipation-the Constipation and Frailty Augmented AHEAD score.Geriatrics & gerontology international · 2025Article
- Effects of Cardiac Rehabilitation Exercise Plus Sacubitril Valsartan Sodium on Cardiac Function, Lung Function, and Quality of Life in Patients with Chronic Heart Failure.Anatolian journal of cardiology · 2025Article
- Impact of exercise on the 21Sports medicine and health science · 2025Review
- Frailty in Pulmonary Hypertension: A Multidimensional Comorbidity.Annals of the American Thoracic Society · 2025Review
- Athlete's Heart Revisited: Historical, Clinical, and Molecular Perspectives.Circulation research · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 9 institutions in 1 country.
Funding
Abstract
backgroundSupervised aerobic exercise training (ET) is recommended for stable outpatients with heart failure (HF) with reduced ejection fraction (HFrEF). Frailty, a syndrome characterized by increased vulnerability and decreased physiologic reserve, is common in patients with HFrEF and associated with a higher risk of adverse outcomes. The effect modification of baseline frailty on the efficacy of aerobic ET in HFrEF is not known.
methodsStable outpatients with HFrEF randomized to aerobic ET versus usual care in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial were included. Baseline frailty was estimated using the Rockwood frailty index (FI), a deficit accumulation-based model of frailty assessment; participants with FI scores >0.21 were identified as frail. Multivariable Cox proportional hazard models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether frailty modified the treatment effect of aerobic ET on the primary composite end point (all-cause hospitalization or mortality), secondary end points (composite of cardiovascular death or cardiovascular hospitalization, and cardiovascular death or HF hospitalization), and Kansas City Cardiomyopathy Questionnaire score. Separate models were constructed for continuous (FI) and categorical (frail versus not frail) measures of frailty.
resultsAmong 2130 study participants (age, 59±13 years; 28% women), 1266 (59%) were characterized as frail (FI>0.21). Baseline frailty burden significantly modified the treatment effect of aerobic ET (
conclusionsAmong patients with chronic stable HFrEF, baseline frailty modified the treatment effect of aerobic ET with a greater reduction in the risk of all-cause hospitalization but not mortality.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.