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[How much frailty is important in cardiology?]
Samuele Baldasseroni1, Mario Bo2, Tiziana Brambati2
1Unità di Terapia Intensiva e Subintensiva Geriatrica, Dipartimento Medico-Geriatrico, Azienda Ospedaliero-Universitaria Careggi, Firenze.
Insights
Cardiovascular disease management in older adults requires more than age-based decisions. Comprehensive Geriatric Assessment (CGA) better predicts outcomes than disease presence, guiding effective clinical decisions for elderly patients.
Area of Science:
- Gerontology
- Cardiology
- Geriatric Medicine
Background:
- Cardiovascular diseases (CVD) prevalence increases with age, posing challenges for older adults.
- Elderly populations are heterogeneous, with complex health states influenced by physiological changes, chronic diseases, and multimorbidity.
- Traditional disease-based assessments are insufficient for older adults; functioning and geriatric syndromes like frailty are critical.
Purpose of the Study:
- To highlight the limitations of age-based criteria in clinical decision-making for older cardiovascular patients.
- To emphasize the importance of standardized assessments beyond disease presence.
- To advocate for the routine use of Comprehensive Geriatric Assessment (CGA) in managing elderly cardiovascular patients.
Main Methods:
- Review of literature on aging, cardiovascular diseases, and geriatric assessment.
- Analysis of the predictive value of Comprehensive Geriatric Assessment (CGA) versus disease-based metrics.
- Discussion of frailty and other geriatric syndromes as determinants of health outcomes.
Main Results:
- Comprehensive Geriatric Assessment (CGA) is a superior predictor of survival and outcomes compared to disease presence or comorbidity extent.
- Frailty, a key geriatric syndrome, signifies increased vulnerability and risk of adverse outcomes in older adults.
- Functioning, rather than disease status, is the most crucial factor for older individuals.
Conclusions:
- Age alone is an inadequate criterion for clinical decisions in elderly cardiovascular care.
- Standardized measures like CGA are essential for identifying older patients who will benefit most from interventions.
- Integrating CGA into daily clinical practice is crucial for optimizing care for aging populations with cardiovascular conditions.
Abstract:
Prevalence and incidence of cardiovascular diseases increase dramatically with advancing age, and older subjects account for the vast majority of patients seeking care either for acute and chronic cardiovascular disorders. In the same time, availability and improvements in drugs and devices, and innovative techniques in interventional cardiology and heart surgery procedures, increased as well, posing crucial challenges in clinical decision-making mainly in older people. Elderly subjects represent a very heterogeneous population and the interplay between underlying physiological change, chronic disease and multimorbidity can result in health states in older ages that are not fully captured by traditional disease classifications and that are often missing in disease-based assessments of health. Geriatric syndromes have been widely recognized as an essential determinant of health status and well-being of older people, although there is some debate as to what disorders these include. Foremost among the geriatric syndromes is frailty, which can be regarded as a progressive age-related deterioration in physiological systems that results in greater vulnerability to stressors and increased risk of adverse outcomes, including care dependence and death. This complexity of health states in older ages means that disease-based conceptualizations are inadequate proxies for health in an older person. Rather than the presence or absence of disease, the most important consideration for older subjects is likely to be their functioning. The Comprehensive Geriatric Assessment (CGA), which evaluates through the use of standardized scales several domains - including comorbidity, cognitive and mood disorders, functional abilities, nutritional status, sarcopenia and frailty - has been demonstrated to be a much better predictor of survival and other outcomes than the presence of diseases or even the extent of comorbidities. Therefore, physicians should be aware that age by itself is probably not the best criterion to rely on for challenging clinical decision-making in this setting. In this clinical context, it becomes mandatory that, beyond age-based decisions or an "eyeballing" perception of "frailty" or "vulnerability", standardized and valid measures aimed at selecting those patients who may potentially derive the greatest benefit from medical or interventional procedures are made available for daily clinical use.
