Should Frailty Assessment Be Integrated into CV Practice?

Assessment of frailty should be integrated into cardiovascular practice in an effort to identify patients who may benefit from frailty interventions and improve health and well-being of older patients, particularly after cardiovascular interventions, according to a state-of-the-art review published Jan. 31 in the Journal of the American College of Cardiology.

Naila Ijaz, MD, et al., discuss the definitions of frailty; instruments used to measure frailty; and proposed interventions to prevent, reverse, or slow the progression of frailty in cardiovascular patients. Frailty is common among older adults who present in cardiovascular practices, but cardiovascular disease and frailty are “interdependent and have the same physiological underpinning that predisposes to the progression of both disease processes,” the authors write.

The authors discuss the association between frailty and cardiovascular disease, as well as instruments used to measure frailty during cardiovascular illness and the challenges of measuring frailty during acute cardiovascular disease. The review also looks at whether frailty is reversible and whether treatment of underlying risk factors of frailty can help identify at-risk patients. In addition, the review provides an overview of frailty interventions, such as physical interventions, which may include cardiac rehabilitation, as well as pharmacologic, dietary, cognitive and psychosocial interventions

Finally, the review discusses gaps in knowledge related to frailty and cardiovascular disease. The authors note that further research is needed on “interventions that reverse frailty and the impacts thereof on long-term cardiovascular outcomes.” They also note that “prospective clinical trial data in older adult populations are needed to better outline the exact interactions among frailty status, [cardiovascular disease] risk factors, and potential downstream consequences, using prespecified and robust frailty assessment methods.”

According to the researchers, frailty is “relevant to the practice of cardiovascular medicine because each disease process can predispose to physical impairments that ultimately cause worsening of cardiovascular illness.” They note that emerging data suggests that multidimensional interventions that include cardiac rehabilitation have been associated with positive outcomes on frailty and physical function among heart failure patients. Efforts to integrate frailty assessment into cardiovascular practice are needed, but “clinical trials to evaluate frailty interventions in specific cardiac populations should further help optimize cardiovascular care in older adults,” they conclude.

Clinical Topics: Cardiovascular Care Team, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Geriatric Assessment, Frail Elderly, Cardiology, Cognition, Heart Failure, Risk Factors, Syndrome, Psychosocial Intervention, Data Visualization, Cardiovascular Diseases, Prospective Studies, Cardiac Rehabilitation, Frailty

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