Multidomain Frailty as a Therapeutic Target in Elderly Patients with Heart Failure

Abstract

Heart failure and frailty share aging as a strong risk factor. The prevalence of frailty has been shown to be particularly high in elderly patients with heart failure. Moreover, it is important not to confine frailty to physical aspects. Rather, it should be considered to consist of multiple domains, including physical disability, psychiatric disorders, cognitive impairment, depression, and social disconnection. Development of interventions that can improve frailty domains are not well established, although observational studies have evaluated the association of various frailty domains and their prognostic impact. Some interventions, including resistance exercise, functional exercise, and respiratory muscle training have been demonstrated to hold potential for improving physical frailty. In terms of cognitive dysfunction, previous studies have demonstrated that exercise therapy is also effective for cognitive dysfunction. The social domain of frailty is one of the least investigated domains, particularly in patients with heart failure. However, heart failure is also strongly associated with physical frailty and cognitive impairment and has a poor prognosis in old patients. The prevalence of social frailty in elderly patients who need hospitalization due to heart failure is higher than previously thought. Very few studies have tested interventions targeting social frailty. Frailty and heart failure affect each other, and both are becoming increasingly important in society. In this article, we review the physical, cognitive, and social domains of frailty and the possible interventions to improve them in patients with heart failure.

The Dual Burden of Frailty and Heart Failure

“…Physical exercise helps counter frailty and is strongly recommended for those frail HF patients able to participate. 44 45 46) Resistance and endurance exercise interventions have shown effectiveness in mitigating muscle loss and in enhancing physical capacity in HF patients.…”

The concurrent impact of mild cognitive impairment and frailty syndrome in heart failure

“…A growing body of scientific knowledge explores models and organization of HF care, facilitation of patients' participation in their self-care and interventions to improve patient outcomes. However, additional research of high quality and rigorous methodology is needed to advance nursing science and improve the lives of patients with HF and their families [ 88 ] In everyday clinical practice, identifying frailty may enable better risk stratification of patients with HF, optimize individualized care plans for patients, minimize negative outcomes, and reduce health care costs [ 89 ]. The assessment of frailty should be part of a comprehensive assessment of HF patients and one of the first steps for accurate risk stratification and a tailored therapeutic plan.…”

“…A growing body of scientific knowledge explores models and organization of HF care, facilitation of patients’ participation in their self-care and interventions to improve patient outcomes. However, additional research of high quality and rigorous methodology is needed to advance nursing science and improve the lives of patients with HF and their families [ 88 ].…”

The multidimensional prognostic index (MPI) predicts long-term mortality in old type 2 diabetes mellitus patients: a 13-year follow-up study

“…The increasing aging of the population has led to a proportional increase in the incidence of age-related conditions and diseases as well, such as sarcopenia [ 1 ], high falling risk, and reduced physical performance [ 2 , 3 ], which lead to increased mortality, and also mild and severe neurocognitive disorders [ 4 ], metabolic syndrome [ 5 ], multifactorial anemia [ 6 ], and cardiovascular diseases, such as hypertension [ 7 ], cardiac failure [ 8 ], and atrial fibrillation [ 9 ]. Among them, Diabetes Mellitus (DM) deserves an honorable mention.…”