title: 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.
authors.affiliation: Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: jonathan.afilalo@mcgill.ca.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Afilalo
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
authors.affiliation: Division of Cardiothoracic Surgery, Baylor Health Care System, The Heart Hospital Baylor Plano, Plano, Texas.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
authors.affiliation: Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Philip
authors.initials: P
authors.lastname: Green
authors.affiliation: Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Popma
authors.affiliation: National Institute on Aging, National Institutes of Health, Baltimore, Maryland.
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, VA Boston Healthcare Center, Boston, Massachusetts.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Forman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000523:psychology; D016330:Frail Elderly / Q000523:psychology; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D011446:Prospective Studies; D012189:Retrospective Studies; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: cardiovascular disease; elderly; frailty