Practical approach on frail older patients attended for acute heart failure

Abstract

Acute heart failure (AHF) is a multi-organ dysfunction syndrome. In addition to known cardiac dysfunction, non-cardiac comorbidity, frailty and disability are independent risk factors of mortality, morbidity, cognitive and functional decline, and risk of institutionalization. Frailty, a treatable and potential reversible syndrome very common in older patients with AHF, increases the risk of disability and other adverse health outcomes. This position paper highlights the need to identify frailty in order to improve prognosis, the risk–benefits of invasive diagnostic and therapeutic procedures, and the definition of older-person-centered and integrated care plans.

The frailty syndrome and outcomes in the TOPCAT trial

“…Frailty is increasingly being recognized as an important effect modifier of traditional cardiac outcome measures . Frailty is a clinical syndrome in which there is physiologic dysregulation.…”

“…Clinically, this translates into limited functional reserves and increased vulnerability to any stressor that threatens homeostasis. Frail patients are at greater risk for death, increased length of hospitalization, falls, institutional placement, and functional decline …”

“…Frailty has been measured using a number of different instruments in clinical trials and observational studies . The approach used to conceptualize frailty generally falls into two groups: frailty defined by phenotype (sometimes termed physical frailty) and frailty defined by a deficit accumulation approach (sometimes termed multi‐dimensional frailty) . This latter approach is a particularly suitable method to rely upon when evaluating frailty and its relationship to outcomes retrospectively from information available in large datasets.…”

“…Frailty is increasingly being recognized as an important effect modifier of traditional cardiac outcome measures. 1,2 Frailty is a clinical syndrome in which there is physiologic dysregulation. Clinically, this translates into limited functional reserves and increased vulnerability to any stressor that threatens homeostasis.…”

“…Frail patients are at greater risk for death, increased length of hospitalization, falls, institutional placement, and functional decline. 1,2 Frailty has been noted in as many as 75% of patients with heart failure, although these studies have not distinguished between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). 1,3 Since HFpEF is predominantly a disorder of older persons with multiple medical co-morbidities, frailty is particularly important to characterize in this population.…”