ALISO VIEJO, Calif. - July 22, 2025 – A multidisciplinary prehabilitation protocol shows promise in reversing frailty and improving outcomes for patients with advanced heart failure who are waiting for surgery.
An article published in AACN Advanced Critical Care describes the development and implementation of a novel preoperative rehabilitation program in the mechanical circulatory support (MCS) program at the Advanced Heart Failure Comprehensive Care Center (AHF CCC) at UCSF Health, part of the University of California, San Francisco (UCSF).
The UCSF MCS program uses left ventricular assist devices (LVADs) and other types of heart pumps to care for patients whose hearts are failing. These patients are often frail, which contributes to poor postoperative outcomes.
Prehabilitation aims to optimize patients’ functional abilities, general health and well-being, to help them better withstand major surgery.
In 2023, the International Society for Heart and Lung Transplantation published a consensus statement recommending frailty assessment as essential for diagnosing and evaluating advanced heart failure and/or candidacy for LVAD therapy. Moreover, the statement highly recommended prehabilitation before implantation of a durable LVAD.
“Novel Acute Care Nurse Practitioner–Led Prehabilitation Protocol in a Mechanical Circulatory Support Program” details the protocol’s four steps and the results from the initial recipient. The protocol’s development and implementation were led by an acute care nurse practitioner (ACNP), with a multidisciplinary team that included nutritionists and physical and occupational therapists.
Lead author Yu Wu, DNP, AGACNP-BC, RN, is an MCS nurse practitioner at UCSF Health’s AHF CCC and clinical assistant professor at UCSF School of Nursing.
“We were able to help a patient go from profound frailty with very poor quality of life to getting strong enough for surgery, having no adverse events or complications, and then continuing to recover and improve on several fronts,” she said. “This article provides data limited to a single patient, and we look forward to continuing this work with a well-designed research study with sufficient sample size.”
Among the results for the patient was a four-fold increase in the distance he was able to walk in six minutes, from 240 feet during the initial assessment to 1,045 feet three months after surgery. In addition, the patient’s cognitive function and quality of life showed measurable improvement, suggesting a reversal of frailty.
After the fourth postoperative day in the critical care unit, the patient was transferred to a progressive care unit and discharged from the hospital on postoperative day 14. The patient continued to do well and successfully received a heart transplant 15 months after the LVAD implementation surgery and hospitalization.
The prehabilitation protocol includes the following:
- Initial Frailty Assessment: establishes baseline data and identifies types of frailty to personalize the intervention
- Patient Education: provides information about prehabilitation and aims to increase motivation to participate
- Multidisciplinary Team Intervention: designed to mitigate risks and optimize the patient’s physical, cognitive and nutritional function
- Reassessment: conducted immediately prior to surgery and repeated three months after hospital discharge
For the article, Wu worked with Jesus Casida, PhD, RN, APN-C, FAAN, professor and Margaret Randolph Research and Innovation Scholar, Mennonite College of Nursing, Illinois State University, Normal. He serves as department editor for the journal’s Issues in Advanced Practice section published in each issue.
“Acute care nurse practitioners and other advanced practice providers continue to demonstrate their leadership and impact on increasing survival and improving other outcomes for patients and their family caregivers,” he said. “This type of initiative is well suited to an ACNP’s expertise in evidence-based clinical management nursing practice.”
AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue also includes a topic-based symposium, feature articles and columns of interest to critical care and progressive care clinicians.
Access the issue by visiting the AACN Advanced Critical Care website at http://acc.aacnjournals.org/.
About AACN Advanced Critical Care: AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses and clinical and academic educators. An official publication of the American Association of Critical-Care Nurses (AACN), the journal has a circulation of 1,500 and can be accessed at http://acc.aacnjournals.org/.
About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.
American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; x.com/aacnme