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Role of frailty assessment in patients undergoing cardiac interventions
Rebecca Rowe1, Javaid Iqbal1, Rachel Murali-Krishnan2
1Department of Cardiovascular Science , University of Sheffield , Sheffield , UK ; Department of Cardiology , Northern General Hospital , Sheffield , UK.
Insights
Frailty assessment is crucial for elderly patients with coronary heart disease. Incorporating frailty into risk scores can improve cardiac intervention decisions and patient quality of life.
Area of Science:
- Gerontology
- Cardiology
- Clinical Medicine
Background:
- Increasing life expectancy leads to more elderly individuals with coronary heart disease (CHD) and comorbidities.
- Elderly frail patients present challenges for invasive cardiac interventions due to risks and quality of life considerations.
- Existing risk scores for cardiac procedures are limited in the elderly, often neglecting frailty and quality of life impacts.
Purpose of the Study:
- To review the association between frailty and cardiovascular disease.
- To analyze the impact of frailty on outcomes of cardiac interventions.
- To propose methods for integrating frailty assessment into cardiology practice.
Main Methods:
- Literature review on frailty, cardiovascular disease, and cardiac interventions.
- Analysis of current risk stratification models and their limitations in elderly populations.
- Exploration of frailty assessment tools and their clinical relevance.
Main Results:
- Frailty assessment serves as a measure of biological age, correlating with quality of life, hospital admissions, and mortality.
- Current risk scores inadequately address frailty and quality of life in elderly cardiac patients.
- Incorporating frailty assessment may lead to more personalized and appropriate care decisions.
Conclusions:
- Frailty is a significant factor in cardiovascular disease outcomes for the elderly.
- Enhanced risk stratification incorporating frailty is needed for elderly patients undergoing cardiac interventions.
- Integrating frailty assessment into clinical practice can optimize care and improve patient-centered outcomes.
Abstract:
Average life expectancy is increasing in the western world resulting in a growing number of frail individuals with coronary heart disease, often associated with comorbidities. Decisions to proceed to invasive interventions in elderly frail patients is challenging because they may gain benefit, but are also at risk of procedure-related complications. Current risk scores designed to predict mortality in cardiac procedures are mainly based on clinical and angiographic factors, with limitations in the elderly because they are mainly derived from a middle-aged population, do not account for frailty and do not predict the impact of the procedure on quality of life which often matters more to elderly patients than mortality. Frailty assessment has emerged as a measure of biological age that correlates well with quality of life, hospital admissions and mortality. Potentially, the incorporation of frailty into current risk assessment models will cause a shift towards more appropriate care. The need for a more accurate method of risk stratification incorporating frailty, particularly for elderly patients is pressing. This article reviews the association between frailty and cardiovascular disease, the impact of frailty on outcomes of cardiac interventions and suggests ways in which frailty assessment could be incorporated into cardiology clinical practice.
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