Frailty in Patients with Cardiovascular Disease: Why, When, and How to Measure
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Frailty in Patients with Cardiovascular Disease: Why, When, and How to Measure Jonathan Afilalo
Published online: 2 August 2011 # The Author(s) 2011. This article is published with open access at Springerlink.com
Abstract Frailty is a geriatric syndrome of impaired resistance to stressors due to a decline in physiologic reserve. Frailty and cardiovascular disease (CVD) share a common biological pathway, and CVD may accelerate the development of frailty. Frailty is identified in 25% to 50% of patients with CVD, depending on the frailty scale used and the population studied. Frail patients with CVD, especially those undergoing invasive procedures or suffering from coronary artery disease and heart failure, are more likely to suffer adverse outcomes as compared to their non-frail counterparts. Five-meter gait speed is a simple and effective way of objectively measuring frailty in patients with CVD and should be incorporated in risk assessment. Keywords Aging . Frailty . Cardiovascular diseases . Cardiac surgery
Introduction The word frail originates from the French frêle, meaning “of little resistance,” and from the Latin fragilis, meaning “easily broken.” In medicine, frailty is a geriatric syndrome used to define older adults with impaired resistance to stressors due to a decline in physiologic reserve [1]. The decline in physiologic reserve is multifactorial and involves a number of organ systems. Implicit in this definition is the introduction of a stressor (illness, J. Afilalo (*) Divisions of Cardiology and Clinical Epidemiology, Department of Medicine, SMBD-Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Montreal, Quebec H3T 1E2, Canada e-mail: [email protected]
surgery) followed by an injury and/or incomplete recovery, and ultimately a greater risk of mortality and morbidity. Frailty has become increasingly relevant in the field of cardiovascular medicine for two principal reasons. First, the patient population is aging; of the 6,160,000 Americans discharged with a first diagnosis of cardiovascular disease (CVD), 62% were ≥65 years of age, and of those not surviving, 67% were ≥75 years or age [2]. Chronologic age alone is insufficient to characterize the heterogeneous group of older adult patients, and consideration of frailty is important to better reflect biological age. Second, there is an emerging body of literature linking CVD and frailty both at the mechanistic level and the epidemiologic level [3]. The objectives of this review are to recapitulate the mechanistic and epidemiologic links between CVD and frailty and to provide a framework for when and how to measure frailty in CVD patients based on current evidence.
Mechanistic Link Between CVD and Frailty Although the pathways leading to CVD and frailty are complex, both have been strongly tied to chronic low-grade inflammation (Fig. 1). Causes of this type of inflammation include lifelong antigenic exposure, angiotensin 1R activation, obesity, insulin resistance, and redox imbalance [4], all of which are found in greater relat
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