Chronic Coronary Syndrome in Frail Old Population

Abstract

The demographic trend of aging is associated with an increased prevalence of comorbidities among the elderly. Physical, immunological, emotional and cognitive impairment, in the context of the advanced biological age segment, leads to the maintenance and precipitation of cardiovascular diseases. Thus, more and more data are focused on understanding the pathophysiological mechanisms underlying each fragility phenotype and how they potentiate each other. The implications of inflammation, sarcopenia, vitamin D deficiency and albumin, as dimensions inherent in fragility, in the development and setting of chronic coronary syndromes (CCSs) have proven their patent significance but are still open to research. At the same time, the literature speculates on the interdependent relationship between frailty and CCSs, revealing the role of the first one in the development of the second. In this sense, depression, disabilities, polypharmacy and even cognitive disorders in the elderly with ischemic cardiovascular disease mean a gradual and complex progression of frailty. The battery of tests necessary for the evaluation of the elderly with CCSs requires a permanent update, according to the latest guidelines, but also an individualized approach related to the degree of frailty and the conditions imposed by it. By summation, the knowledge of frailty screening methods, through the use of sensitive and individualized tools, is the foundation of secondary prevention and prognosis in the elderly with CCSs. Moreover, a comprehensive geriatric assessment remains the gold standard of the medical approach of these patients. The management of the frail elderly, with CCSs, brings new challenges, also from the perspective of the treatment particularities. Sometimes the risk–benefit balance is difficult to achieve. Therefore, the holistic, individualized and updated approach of these patients remains a desired objective, by understanding and permanently acquiring knowledge on the complexity of the frailty syndrome.

Fried Frailty Phenotype in Elderly Patients with Chronic Coronary Syndrome: Prevalence, Associated Factors, and Impact on Hospitalization

“…The aging process predisposes the elderly to a higher risk of having concurrently geriatric syndromes and coronary syndromes. 17 The elderly patients with coronary syndromes can be underdiagnosed, undermanaged, and have more adverse clinical events attributable to frailty. 3 According to previous guidelines, assessment of frailty in elderly patients with coronary syndromes can improve clinical decision-making by informing the prediction of the benefits of revascularization or the risk of adverse reactions.…”

Ischemic Heart Disease in the Context of Different Comorbidities

“…Ilie et al debated the strong relationship between frailty and chronic coronary syndromes [ 2 ]. They discussed the mechanisms of the bidirectional interaction between frailty—a complex geriatric syndrome with many phenotypes—and increased risk of ischemic coronary events.…”