Frailty assessment in the management of cardiovascular disease

Wilkinson, Chris; Rockwood, Kenneth

doi:10.1136/heartjnl-2022-321265

Cited by 7 publications

(6 citation statements)

References 29 publications

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“…Additionally, frailty is associated with a higher incidence of both cardiac and noncardiac comorbidities, further amplifying the overall risk of mortality. 7 On the other hand, there is a greater risk of a fatal outcome when the implantation occurs during a nonelective hospitalization, a significant finding in our study where the vast majority of hospitalizations were nonelective, indicating a higher-risk group. Moreover, the implantation of a pacemaker itself may trigger stress responses in frail patients, thereby leading to prolonged hospital stays, increased morbidity, and ultimately poorer outcomes.…”

Section: Discussionmentioning

confidence: 47%

“… 6 It has been shown to be associated with increased mortality, hospitalization, and other adverse events in patients undergoing cardiac interventions, including cardiac surgery and transcatheter aortic valve replacement. 7 However, the role of frailty in predicting outcomes in patients undergoing leadless pacemaker implantation has not been well characterized. Therefore, this study aims to evaluate the association between frailty and clinical outcomes in patients undergoing leadless pacemaker implantation using nationwide real-world data.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association between frailty and in-hospital outcomes in patients undergoing leadless pacemaker implantation: A nationwide analysis

Diaz-Arocutipa,

Calderon-Ramirez,

Mayta-Tovalino

et al. 2024

Heart Rhythm O2

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Section: Discussionmentioning

confidence: 47%

Section: Introductionmentioning

confidence: 99%

Association between frailty and in-hospital outcomes in patients undergoing leadless pacemaker implantation: A nationwide analysis

Diaz-Arocutipa,

Calderon-Ramirez,

Mayta-Tovalino

et al. 2024

Heart Rhythm O2

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“…The Barthel index is used for assessment of performance in basic activities of daily living 31–33. The CFS is a clinical judgement-based frailty tool and is widely used in the assessment of cardiac patients 24 34…”

Section: Methodsmentioning

confidence: 99%

Feasibility study of rehabilitation for cardiac patients aided by an artificial intelligence web-based programme: a randomised controlled trial (RECAP trial)—a study protocol

Witharana,

Chang,

Maier

et al. 2024

BMJ Open

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IntroductionCardiac rehabilitation (CR) delivered by rehabilitation specialists in a healthcare setting is effective in improving functional capacity and reducing readmission rates after cardiac surgery. It is also associated with a reduction in cardiac mortality and recurrent myocardial infarction. This trial assesses the feasibility of a home-based CR programme delivered using a mobile application (app).MethodsThe Rehabilitation through Exercise prescription for Cardiac patients using an Artificial intelligence web-based Programme (RECAP) randomised controlled feasibility trial is a single-centre prospective study, in which patients will be allocated on a 1:1 ratio to a home-based CR programme delivered using a mobile app with accelerometers or standard hospital-based rehabilitation classes. The home-based CR programme will employ artificial intelligence to prescribe exercise goals to the participants on a weekly basis. The trial will recruit 70 patients in total. The primary objectives are to evaluate participant recruitment and dropout rates, assess the feasibility of randomisation, determine acceptability to participants and staff, assess the rates of potential outcome measures and determine hospital resource allocation to inform the design of a larger randomised controlled trial for clinical efficacy and health economic evaluation. Secondary objectives include evaluation of health-related quality of life and 6 minute walk distance.Ethics and disseminationRECAP trial received a favourable outcome from the Berkshire research ethics committee in September 2022 (IRAS 315483).Trial results will be made available through publication in peer-reviewed journals and presented at relevant scientific meetings.Trial registration numberISRCTN97352737.

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“…Several methods have been employed in standardizing the definition of frailty in patients with HF, mostly for purposes of prognostication and studying differential therapeutic benefits of relevant interventions in clinical trials. 24 A systematic review identified 67 instruments that have been employed to measure frailty, and the two most cited scales are the Fried frailty phenotype (also known as the patient frailty phenotype) and the deficit accumulation index proposed by Rockwood and colleagues. 25 The Fried frailty phenotype was pioneered by Fried et al and has been widely adopted in medical literature for frailty assessment.…”

Section: Frailty Assessment In Heart Failurementioning

confidence: 99%

Frailty and heart failure: State‐of‐the‐art review

Talha,

Pandey,

Fudim

et al. 2023

J cachexia sarcopenia muscle

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At least half of all patients with heart failure (HF) are affected by frailty, a syndrome that limits an individual ability to recover from acute stressors. While frailty affects up to 90% of patients with HF with preserved ejection fraction, it is also seen in ~30–60% of patients with HF with reduced ejection fraction, with ~26% higher prevalence in women compared with men. The relationship between frailty and HF is bidirectional, with both conditions exacerbating the other. Frailty is further complicated by a higher prevalence of sarcopenia (by ~20%) in HF patients compared with patients without HF, which negatively affects outcomes. Several frailty assessment methods have been employed historically including the Fried frailty phenotype and Rockwood Clinical Frailty Scale to classify HF patients based on the severity of frailty; however, a validated HF‐specific frailty assessment tool does not currently exist. Frailty in HF is associated with a poor prognosis with a 1.5‐fold to 2‐fold higher risk of all‐cause death and hospitalizations compared to non‐frail patients. Frailty is also highly prevalent in patients with worsening HF, affecting >50% of patients hospitalized for HF. Such patients with multiple readmissions for decompensated HF have markedly poor outcomes compared to younger, non‐frail cohorts, and it is hypothesized that it may be due to major physical and functional limitations that limit recovery from an acute episode of worsening HF, a care aspect that has not been addressed in HF guidelines. Frail patients are thought to confer less benefit from therapeutic interventions due to an increased risk of perceived harm, resulting in lower adherence to HF interventions, which may worsen outcomes. Multiple studies report that <40% of frail patients are on guideline‐directed medical therapy for HF, of which most are on suboptimal doses of these medications. There is a lack of evidence generated from randomized trials in this incredibly vulnerable population, and most current practice is governed by post hoc analyses of trials, observational registry‐based data and providers' clinical judgement. The current body of evidence suggests that the treatment effect of most guideline‐based interventions, including medications, cardiac rehabilitation and device therapy, is consistent across all age groups and frailty subgroups and, in some cases, may be amplified in the older, more frail population. In this review, we discuss the characteristics, assessment tools, impact on prognosis and impact on therapeutic interventions of frailty in patients with HF.

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Frailty assessment in the management of cardiovascular disease

Cited by 7 publications

References 29 publications

Association between frailty and in-hospital outcomes in patients undergoing leadless pacemaker implantation: A nationwide analysis

Association between frailty and in-hospital outcomes in patients undergoing leadless pacemaker implantation: A nationwide analysis

Feasibility study of rehabilitation for cardiac patients aided by an artificial intelligence web-based programme: a randomised controlled trial (RECAP trial)—a study protocol

Frailty and heart failure: State‐of‐the‐art review

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