Frailty Assessment in the Cardiovascular Care of Older Adults

Abstract

Due to the aging and increasingly complex nature of our patients, frailty has become a high-priority theme in cardiovascular medicine. Despite the recognition of frailty as a pivotal element in the evaluation of older adults with cardiovascular disease (CVD), there has yet to be a road map to facilitate its adoption in routine clinical practice. Thus, we sought to synthesize the existing body of evidence and offer a perspective on how to integrate frailty into clinical practice. Frailty is a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors. Upward of 20 frailty assessment tools have been developed, with most tools revolving around the core phenotypic domains of frailty—slow walking speed, weakness, inactivity, exhaustion, and shrinking—as measured by physical performance tests and questionnaires. The prevalence of frailty ranges from 10% to 60%, depending on the CVD burden, as well as the tool and cutoff chosen to define frailty. Epidemiological studies have consistently demonstrated that frailty carries a relative risk of >2 for mortality and morbidity across a spectrum of stable CVD, acute coronary syndromes, heart failure, and surgical and transcatheter interventions. Frailty contributes valuable prognostic insights incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients. Interventions designed to improve outcomes in frail elders with CVD such as multidisciplinary cardiac rehabilitation are being actively tested. Ultimately, frailty should not be viewed as a reason to withhold care but rather as a means of delivering it in a more patient-centered fashion.

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

“…Ocena ta jest podobna do przeprowadzanej u chorych kwalifikowanych do przezcewnikowej implantacji zastawki aortalnej [420]. Zidentyfikowano zespół kruchości jako silny, niezależny czynnik predykcyjny wewnątrzszpitalnej i 30-dniowej śmier-telności u pacjentów w podeszłym wieku z NSTE-ACS [421].…”

Frailty and perioperative outcomes: a narrative review

“…[3][4][5] This in turn increases the risk of adverse clinical consequences to stressors. 6 Indeed, Afilalo et al 7 have classified stressors as falling into the categories of acute or chronic illness as well as due to iatrogenic processes.…”

“…6,15 With respect to biomarkers, IL-6 may be an important factor, as increased plasma levels have the highest association with frailty. 18 Similarly, Afilalo et al also mention other biomarkers that have a correlation with frailty, 7 some of them being markers of inflammation. These included lymphocyte count, memory/naïve CD8 T-cell count, plasminogen activator inhibitor-1, testosterone, insulin-like growth factor-1, albumin, and vitamin D. With no widely universal definition of frailty 6 and the creation of many frailty scales, it is reasonable to question why frailty is measured.…”

Association of Age to Mortality and Repeat Revascularization in End-Stage Renal Disease Patients: Implications for Clinicians and Future Health Policies

“…We specifically did not evaluate how age as a continuous variable modifies the effect or interacts with baseline comorbidities, either individually or by the number of comorbidities 27 as well as with indices of frailty. 28 We also did not assess how changes in the placement of knots for the cubic spline affected results.…”