The Application of Frailty to the Modern Cardiac Risk Assessment: a Case-Based Review
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ELDERLY + HEART DISEASE (K DHARMARAJAN, SECTION EDITOR)
The Application of Frailty to the Modern Cardiac Risk Assessment: a Case-Based Review Matthew Finn 1,2 & Philip Green 1
Published online: 7 October 2015 # Springer Science+Business Media New York 2015
Abstract Cardiac risk assessment in aging patients poses a significant challenge to the practicing clinician, particularly when evaluating the use of invasive procedures. Frailty is a valuable risk marker that has been associated with worse outcomes in patients with coronary artery disease, heart failure, and aortic stenosis. Integrating the available frailty studies into cardiac risk assessments can help improve shared decision-making between physicians and their patients. In this review, we provide an up-todate, case-based appraisal of the available clinical trial data focusing on the impact of frailty in patients with cardiovascular disease. Keywords Frailty . Cardiac risk assessment . Aging . Geriatric . Elderly . Aortic stenosis . Transcatheter aortic valve replacement . Coronary artery disease . Heart failure
Abbreviations AMI Acute myocardial infarction CVD Cardiovascular disease CAD Coronary artery disease HF Heart failure SAVR Surgical aortic valve replacement STS Society thoracic surgeons TAVR Transcatheter aortic valve replacement
Introduction The evolution of modern medicine has enabled many individuals to approach their Bnatural life span,^ the maximum age one could expect to live under optimal conditions. Longer life spans have lead to a higher incidence of disability, comorbidity, and diminished functional independence in older adults [1•]. The term frailty has been utilized to encompass this clinical phenotype. Frailty is defined as a state of overall susceptibility in which a person has decreased physical reserve, resulting in a greater possibility of unfavorable outcomes when a stressor is applied. The idea of frailty as a clinically significant predictor of outcomes was originally proposed and tested by Fried et al. in the Cardiovascular Health Study. In the study, frailty was evaluated based on five parameters: overall physical activity level, unintentional weight loss, slow walking speeds, fatigue, and degree of weakness [2]. Subsequent studies have used a variety of alternative markers for frailty including cognitive impairment, number of comorbid conditions, albumin level, and loss of independent living (Table 1) [3, 4]. The bio-pathologic basis of frailty is thought to comprise aging-associated Bwear and tear^ coupled with aging-related biologic changes that lead to subclinical multi-system dysfunction. The existence of a stressor (in the form of an illness) transforms Bsubclinical^ disease into Bclinical^ disease and results in significant unfavorable effects [5•, 6].
This article is part of the Topical Collection on Elderly + Heart Disease * Matthew Finn [email protected] 1
Department of Cardiology, Columbia University Medical Center, New York, NY, USA
2
Division of Cardiology, 622 West 168th Street, PH 3-347, New York,
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