Editor’s Choice - Frailty and the management of patients with acute cardiovascular disease: A position paper from the Acute Cardiovascular Care Association

Walker, David; Gale, Chris P; Lip, Gregory Y. H.; Martín-Sánchez, F.J.; McIntyre, Hugh; Müeller, Christian; Price, Susanna; Sanchís, Juan; Vidán, María Teresa; Wilkinson, Chris; Zeymer, Uwe; Bueno, Héctor

doi:10.1177/2048872618758931

Cited by 80 publications

(63 citation statements)

References 173 publications

(252 reference statements)

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“…disability, death, hospitalisation or institutionalisation) 23,24 so identify those who need early intervention and close monitoring. 25 The recognition of frailty is the first step for an accurate risk stratification and planning a tailored therapeutic plan. 26,27 However, several knowledge gaps exist.…”

Section: Assessment and Management Of Frailty In Hfmentioning

confidence: 99%

Frailty in Heart Failure: Implications for Management

Vitale

Spoletini

Rosano

2018

Cardiac Failure Review

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Frailty is a complex clinical syndrome associated with ageing and chronic illness, resulting from multiple organ impairment; physiological reserves decrease and vulnerability to stressors increase. The role of frailty in cardiovascular disease has become increasingly recognised. Up to 79% of patients with heart failure are frail. Moreover, frailty is associated with a worse quality of life and poor prognosis. This review summarises the available literature on frailty in HF and highlights indications for its management.

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Section: Assessment and Management Of Frailty In Hfmentioning

confidence: 99%

Frailty in Heart Failure: Implications for Management

Vitale

Spoletini

Rosano

2018

Cardiac Failure Review

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“…According to the World Health Organization (WHO), "there are 32.4 million myocardial infarctions and strokes worldwide every year [5]." The incidence of acute coronary events reflects the rise in age which has been observed in general populations; "20% of patients aged over 65 years receive percutaneous coronary interventions and 27% of patients aged over 70 years receiving coronary angiography [6]. " It so happens that all of these patients exhibit the typical configuration of frailty.…”

Section: Myocardial Infarction: a Global Threatmentioning

confidence: 99%

“…Frail subjects are also more likely to present with a coronary event. Similarly, patients with cardiovascular disease are more likely to have a " functional impairment" alluding to a frail status [6].…”

Section: Myocardial Infarction: a Global Threatmentioning

confidence: 99%

“…Although a great deal of effort and advancements have been made to allow for dissolution of an MI and reduce likelihood of recurrence or complications, it is still a major vehicle for all-cause mortality. An acute coronary syndrome alone imposes a great deal of stress on the human body [6]. Even so, studies show that cardiac-related risk factors are not sufficient to explain neither the development, progression nor adverse effects of MI.…”

Section: Myocardial Infarction: a Global Threatmentioning

confidence: 99%

“…Even so, studies show that cardiac-related risk factors are not sufficient to explain neither the development, progression nor adverse effects of MI. Frail individuals have "longer lengths of hospital stay and are more likely to be readmitted with recurrent cardiovascular events [6]. "…”

Section: Myocardial Infarction: a Global Threatmentioning

confidence: 99%

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Frailty in Myocardial Infarction Patients: A Paradigm Shift

Hassan¹,

Ibrahim²,

Ellahham³

2019

Cardiovasc Pharm Open Access

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An insightful review of evidence-based literature unveils a drastically increasing incidence of myocardial infarction (MI). As the global population becomes older, the frequency of adverse coronary events escalates proportionally. The modifiable and non-modifiable risk factors that contribute toward the development of MI have been enumerated, and the aftereffects which may follow are known to be even more detrimental. Nevertheless, it is imperative to acknowledge that the management of MI patients does not only surround their cardiovascular health but is governed by many other seemingly superfluous concerns-some of which fall under the umbrella of frailty. A coalesce of frailty identification and appreciation of its subsequent role in prognostication and management is revolutionary. This further proves the need for considerable collaboration between geriatricians that meticulously deliberate the quintessential all-round care of the elderly as well as the cardiologists whose aim is to optimize cardiac function, survival and quality of life. Thus, the purpose of this mini-review is to ponder upon and adopt a validated assessment tool for the purposes of diagnosing frailty and prognostication amongst MI. This will allow for purposeful formulation of individualized management plans that could reduce the rates of mounting morbidities and all-cause mortality.

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Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non–ST-Segment Elevation Acute Myocardial Infarction

et al. 2023

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ImportanceTo our knowledge, no randomized clinical trial has compared the invasive and conservative strategies in frail, older patients with non–ST-segment elevation acute myocardial infarction (NSTEMI).ObjectiveTo compare outcomes of invasive and conservative strategies in frail, older patients with NSTEMI at 1 year.Design, Setting, and ParticipantsThis multicenter randomized clinical trial was conducted at 13 Spanish hospitals between July 7, 2017, and January 9, 2021, and included 167 older adult (≥70 years) patients with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. Data analysis was performed from April 2022 to June 2022.InterventionsPatients were randomized to routine invasive (coronary angiography and revascularization if feasible; n = 84) or conservative (medical treatment with coronary angiography for recurrent ischemia; n = 83) strategy.Main Outcomes and MeasuresThe primary end point was the number of days alive and out of the hospital (DAOH) from discharge to 1 year. The coprimary end point was the composite of cardiac death, reinfarction, or postdischarge revascularization.ResultsThe study was prematurely stopped due to the COVID-19 pandemic when 95% of the calculated sample size had been enrolled. Among the 167 patients included, the mean (SD) age was 86 (5) years, and mean (SD) Clinical Frailty Scale score was 5 (1). While not statistically different, DAOH were about 1 month (28 days; 95% CI, −7 to 62) greater for patients managed conservatively (312 days; 95% CI, 289 to 335) vs patients managed invasively (284 days; 95% CI, 255 to 311; P = .12). A sensitivity analysis stratified by sex did not show differences. In addition, we found no differences in all-cause mortality (hazard ratio, 1.45; 95% CI, 0.74-2.85; P = .28). There was a 28-day shorter survival in the invasive vs conservatively managed group (95% CI, −63 to 7 days; restricted mean survival time analysis). Noncardiac reasons accounted for 56% of the readmissions. There were no differences in the number of readmissions or days spent in the hospital after discharge between groups. Neither were there differences in the coprimary end point of ischemic cardiac events (subdistribution hazard ratio, 0.92; 95% CI, 0.54-1.57; P = .78).Conclusions and RelevanceIn this randomized clinical trial of NSTEMI in frail older patients, there was no benefit to a routine invasive strategy in DAOH during the first year. Based on these findings, a policy of medical management and watchful observation is recommended for older patients with frailty and NSTEMI.Trial RegistrationClinicalTrials.gov Identifier: NCT03208153

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Editor’s Choice - Frailty and the management of patients with acute cardiovascular disease: A position paper from the Acute Cardiovascular Care Association

Cited by 80 publications

References 173 publications

Frailty in Heart Failure: Implications for Management

Frailty in Heart Failure: Implications for Management

Frailty in Myocardial Infarction Patients: A Paradigm Shift

Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non–ST-Segment Elevation Acute Myocardial Infarction

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