Frailty assessment in the cardiovascular care of older adults

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 facili...

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Published in:	Journal of the American College of Cardiology Vol. 63; no. 8; p. 747
Main Authors:	Afilalo, Jonathan, Alexander, Karen P, Mack, Michael J, Maurer, Mathew S, Green, Philip, Allen, Larry A, Popma, Jeffrey J, Ferrucci, Luigi, Forman, Daniel E
Format:	Journal Article
Language:	English
Published:	United States 04.03.2014
Subjects:	Aged Aged, 80 and over Cardiovascular Diseases - diagnosis Cardiovascular Diseases - psychology Frail Elderly - psychology Geriatric Assessment - methods Humans Prospective Studies Retrospective Studies Surveys and Questionnaires - standards cardiovascular disease frailty elderly
ISSN:	1558-3597, 1558-3597
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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.
AbstractList	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. 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.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.
Author	Green, Philip Allen, Larry A Afilalo, Jonathan Forman, Daniel E Alexander, Karen P Mack, Michael J Maurer, Mathew S Popma, Jeffrey J Ferrucci, Luigi
Author_xml	– sequence: 1 givenname: Jonathan surname: Afilalo fullname: Afilalo, Jonathan email: jonathan.afilalo@mcgill.ca organization: Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: jonathan.afilalo@mcgill.ca – sequence: 2 givenname: Karen P surname: Alexander fullname: Alexander, Karen P organization: Division of Cardiology, Duke University Medical Center, Durham, North Carolina – sequence: 3 givenname: Michael J surname: Mack fullname: Mack, Michael J organization: Division of Cardiothoracic Surgery, Baylor Health Care System, The Heart Hospital Baylor Plano, Plano, Texas – sequence: 4 givenname: Mathew S surname: Maurer fullname: Maurer, Mathew S organization: Division of Cardiology, Columbia University Medical Center, New York, New York – sequence: 5 givenname: Philip surname: Green fullname: Green, Philip organization: Division of Cardiology, Columbia University Medical Center, New York, New York – sequence: 6 givenname: Larry A surname: Allen fullname: Allen, Larry A organization: Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado – sequence: 7 givenname: Jeffrey J surname: Popma fullname: Popma, Jeffrey J organization: Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts – sequence: 8 givenname: Luigi surname: Ferrucci fullname: Ferrucci, Luigi organization: National Institute on Aging, National Institutes of Health, Baltimore, Maryland – sequence: 9 givenname: Daniel E surname: Forman fullname: Forman, Daniel E organization: Division of Cardiovascular Medicine, Brigham and Women's Hospital, VA Boston Healthcare Center, Boston, Massachusetts
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/24291279$$D View this record in MEDLINE/PubMed
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JACC Cardiovasc Interv. 2011 Sep;4(9):1020-7
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Snippet	Due to the aging and increasingly complex nature of our patients, frailty has become a high-priority theme in cardiovascular medicine. Despite the recognition...
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SubjectTerms	Aged Aged, 80 and over Cardiovascular Diseases - diagnosis Cardiovascular Diseases - psychology Frail Elderly - psychology Geriatric Assessment - methods Humans Prospective Studies Retrospective Studies Surveys and Questionnaires - standards
Title	Frailty assessment in the cardiovascular care of older adults
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