Prognostic and Therapeutic Implications of Frailty in Older Adults with Heart Failure

Abstract

Frailty is increasingly recognized in older adults with cardiovascular disease, particularly in those with heart failure (HF). A growing body of evidence has shown that frailty has a negative effect on survival, hospitalizations, disability, and quality of life. Beyond frailty, additional domains captured by a comprehensive geriatric assessment contribute incremental value in predicting outcomes and identifying treatment targets. Exercise training is ideally suited to this setting as it can concomitantly improve physical frailty and HF symptoms. Multidisciplinary disease management programs offer a number of benefits for frail HF patients; invasive procedures carry a higher risk of morbidity than in non-frail counterparts, and evidence-based drugs and devices have an uncertain value and warrant further research. While more data accrues, difficult therapeutic decisions should be individualized using a shared patient-centered decision making approach.

Heart Failure Association of the European Society of Cardiology position paper on frailty in patients with heart failure

“…The presence of frailty has a negative impact on the prognosis of patients with HF. Frailty accelerates the progression of HF and increases morbidity and mortality in these patients . Frailty contributes to a higher risk of mortality at 1 year, increased HF hospitalisations with longer bed days in hospital, and a decreased probability of surviving more than 10 years.…”

“…Frailty accelerates the progression of HF and increases morbidity and mortality in these patients. 24,[29][30][31] Frailty…”

Hypertension and Frailty Syndrome in Old Age: Current Perspectives

“…Important factors include early identification of polypharmacy by the treatment team, implementing appropriate treatment for comorbidities, identifying cognitive impairment and low mood, providing psychological support and preventing falls. 44 In recent years, a number of prevention programs have been launched that promote screening tests enabling quick identification of patients who are frail or at risk of frailty such as the FRAIL scale 39 and the TFI. 41 Consistent prevention activity programs have become a priority for many health care facilities and teams.…”

The prognostic significance of frailty compared to peak oxygen consumption and B‐type natriuretic peptide in patients with advanced heart failure

“…The assessment of frailty has traditionally taken place in the geriatric population, where a frail phenotype portends increased morbidity and mortality . Previous studies have assessed the role of frailty among elderly patients undergoing cardiac interventions, showing that frailty was associated with an increased risk of incident heart failure, and a higher risk of hospitalizations and mortality …”

“…1,[3][4][5] Previous studies have assessed the role of frailty among elderly patients undergoing cardiac interventions, showing that frailty was associated with an increased risk of incident heart failure, and a higher risk of hospitalizations and mortality. 6 More recently, assessment of frailty has become an integral part of the evaluation of potential candidates for heart transplantation and ventricular assist device (HTx/VAD). 7 The 2016 ISHLT guidelines on listing criteria for heart transplantation recognize the growing interest in the use of frailty metrics when assessing candidacy.…”