Author + information
- Received September 25, 2013
- Accepted September 30, 2013
- Published online March 4, 2014.
- Jonathan Afilalo, MD, MSc∗∗ (, )
- Karen P. Alexander, MD†,
- Michael J. Mack, MD‡,
- Mathew S. Maurer, MD§,
- Philip Green, MD§,
- Larry A. Allen, MD, MPH‖,
- Jeffrey J. Popma, MD¶,
- Luigi Ferrucci, MD, PhD# and
- Daniel E. Forman, MD∗∗
- ∗Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- †Division of Cardiology, Duke University Medical Center, Durham, North Carolina
- ‡Division of Cardiothoracic Surgery, Baylor Health Care System, The Heart Hospital Baylor Plano, Plano, Texas
- §Division of Cardiology, Columbia University Medical Center, New York, New York
- ‖Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
- ¶Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- #National Institute on Aging, National Institutes of Health, Baltimore, Maryland
- ∗∗Division of Cardiovascular Medicine, Brigham and Women's Hospital, VA Boston Healthcare Center, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Jonathan Afilalo, Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, 3755 Cote Sainte Catherine Road, E-222, Montreal, Quebec H3T 1E2, Canada.
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.
Dr. Popma has received research grants from Medtronic, Boston Scientific, and Abbott; and has served on advisory boards for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 25, 2013.
- Accepted September 30, 2013.
- American College of Cardiology Foundation