Frailty-targeted cardiovascular rehabilitation and management in older adults with cardiovascular disease and frailty: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness and delivery characteristics of frailty-related cardiovascular rehabilitation and management interventions for older adults with cardiovascular disease and frailty. METHODS: We systematically reviewed randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) identified through searches of PubMed, Embase, Web of Science, CINAHL via EBSCOhost, and the Cochrane Library from inception to 30 April 2026. Random-effects meta-analyses used conventional restricted maximum-likelihood estimation. Certainty of evidence was assessed using the GRADE framework. RESULTS: Sixteen studies (13 RCTs and 3 NRSIs; 1,716 enrolled participants) were included. Significant effects favoured the intervention on adjusted/model-based Short Physical Performance Battery (SPPB) (MD 1.20 points, 95% CI 0.54 to 1.87; k=2), 6-minute walk distance (MD 29.84m, 95% CI 15.81 to 43.87; k=2), frailty burden (Hedges'g [bias-corrected SMD] -1.94, 95% CI -2.99 to -0.88; k=2), lower-limb strength (Hedges'g [bias-corrected SMD] 1.48, 95% CI 0.42 to 2.55; k=2), and SPPB decline (RR 0.32, 95% CI 0.16 to 0.67; k=3), but not on unadjusted SPPB, SPPB improvement, handgrip strength, Barthel scores, or all-cause mortality. Hospitalization and quality-of-life outcomes were not pooled for uncomparable definitions or constructs. Safety, implementation and economic evaluation were heterogeneously or even not reported. The certainty of evidence was rated as very low. CONCLUSIONS: The evidence suggests favourable but uncertain signals for selected proximal functional outcomes, with no clear benefit for distal clinical outcomes. These findings remain exploratory, and clinically meaningful benefit has not been established, given the limited evidence base, risk of bias, heterogeneity, imprecision, and very low certainty of evidence.