Frailty and Cardiovascular Outcome

Frailty and cardiovascular outcome

In an article in the Journal of American College of Cardiology, [1] Jonathan and colleagues addressed the issue of frailty in the elderly and its influence on cardiovascular outcomes. Frailty is a biological state in the elderly with decreased functional reserve and undue vulnerability to various stressors. Important domains in the evaluation of frailty are slow walking speeds, general weakness, poor physical activity, undue exhaustion and shrinking of body size in the elderly. Frailty may have a prevalence of up to 60% and it has a relative risk above two for mortality and morbidity in those with cardiovascular disorders including those undergoing cardiovascular interventions.

JACC State-of-the-Art Review in 2022 has addressed this issue further. Pathophysiological mechanisms for the development of frailty include cognitive decline, physical inactivity, poor nutrition and lack of social support. Data from patients admitted with heart failure indicate that interventions for frailty are associated with positive outcomes and needed tailored cardiac rehabilitation, particularly after cardiovascular interventions [2]. Various types of interventions used are physical, pharmacological, cognitive, nutritional and psychosocial and combinations of these. Prevention has been addressed as primary prevention for preventing the onset of frailty, secondary prevention for reversal of frailty and tertiary prevention for improving quality of life in older patients with preexisting frailty.

References

1. Jonathan Afilalo, Karen P Alexander, Michael J Mack, Mathew S Maurer, Philip Green, Larry A Allen, Jeffrey J Popma, Luigi Ferrucci, Daniel E Forman. Frailty Assessment in the Cardiovascular Care of Older Adults. J Am Coll Cardiol. 2014;63(8):747-762.
2. Ijaz N, Buta B, Xue QL, Mohess DT, Bushan A, Tran H, Batchelor W, deFilippi CR, Walston JD, Bandeen-Roche K, Forman DE, Resar JR, O’Connor CM, Gerstenblith G, Damluji AA. Interventions for Frailty Among Older Adults With Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022 Feb 8;79(5):482-503. doi: 10.1016/j.jacc.2021.11.029. PMID: 35115105; PMCID: PMC8852369.