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Role of frailty assessment in patients undergoing cardiac interventions.

Rowe R, Iqbal J, Murali-Krishnan R, Sultan A, Orme R, Briffa N, Denvir M, Gunn J - Open Heart (2014)

Bottom Line: Decisions to proceed to invasive interventions in elderly frail patients is challenging because they may gain benefit, but are also at risk of procedure-related complications.Current risk scores designed to predict mortality in cardiac procedures are mainly based on clinical and angiographic factors, with limitations in the elderly because they are mainly derived from a middle-aged population, do not account for frailty and do not predict the impact of the procedure on quality of life which often matters more to elderly patients than mortality.This article reviews the association between frailty and cardiovascular disease, the impact of frailty on outcomes of cardiac interventions and suggests ways in which frailty assessment could be incorporated into cardiology clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Science , University of Sheffield , Sheffield , UK ; Department of Cardiology , Northern General Hospital , Sheffield , UK.

ABSTRACT
Average life expectancy is increasing in the western world resulting in a growing number of frail individuals with coronary heart disease, often associated with comorbidities. Decisions to proceed to invasive interventions in elderly frail patients is challenging because they may gain benefit, but are also at risk of procedure-related complications. Current risk scores designed to predict mortality in cardiac procedures are mainly based on clinical and angiographic factors, with limitations in the elderly because they are mainly derived from a middle-aged population, do not account for frailty and do not predict the impact of the procedure on quality of life which often matters more to elderly patients than mortality. Frailty assessment has emerged as a measure of biological age that correlates well with quality of life, hospital admissions and mortality. Potentially, the incorporation of frailty into current risk assessment models will cause a shift towards more appropriate care. The need for a more accurate method of risk stratification incorporating frailty, particularly for elderly patients is pressing. This article reviews the association between frailty and cardiovascular disease, the impact of frailty on outcomes of cardiac interventions and suggests ways in which frailty assessment could be incorporated into cardiology clinical practice.

No MeSH data available.


Related in: MedlinePlus

Schematic representation of the pathophysiology of frailty.
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OPENHRT2013000033F1: Schematic representation of the pathophysiology of frailty.

Mentions: Increasing life expectancy is resulting in a corresponding rise in the average age of patients presenting with cardiovascular diseases (CVDs). Ageing is characterised by a reduction in functional reserve. Frailty is an increased vulnerability to minor stressors that develops because of age-related decline. With frailty, this decline is accelerated and homoeostatic mechanisms start to fail.1 Apoptosis, senescence, repair, inflammation and immune activation have all been implicated as pathways responsible for this decline (figure 1).


Role of frailty assessment in patients undergoing cardiac interventions.

Rowe R, Iqbal J, Murali-Krishnan R, Sultan A, Orme R, Briffa N, Denvir M, Gunn J - Open Heart (2014)

Schematic representation of the pathophysiology of frailty.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195918&req=5

OPENHRT2013000033F1: Schematic representation of the pathophysiology of frailty.
Mentions: Increasing life expectancy is resulting in a corresponding rise in the average age of patients presenting with cardiovascular diseases (CVDs). Ageing is characterised by a reduction in functional reserve. Frailty is an increased vulnerability to minor stressors that develops because of age-related decline. With frailty, this decline is accelerated and homoeostatic mechanisms start to fail.1 Apoptosis, senescence, repair, inflammation and immune activation have all been implicated as pathways responsible for this decline (figure 1).

Bottom Line: Decisions to proceed to invasive interventions in elderly frail patients is challenging because they may gain benefit, but are also at risk of procedure-related complications.Current risk scores designed to predict mortality in cardiac procedures are mainly based on clinical and angiographic factors, with limitations in the elderly because they are mainly derived from a middle-aged population, do not account for frailty and do not predict the impact of the procedure on quality of life which often matters more to elderly patients than mortality.This article reviews the association between frailty and cardiovascular disease, the impact of frailty on outcomes of cardiac interventions and suggests ways in which frailty assessment could be incorporated into cardiology clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Science , University of Sheffield , Sheffield , UK ; Department of Cardiology , Northern General Hospital , Sheffield , UK.

ABSTRACT
Average life expectancy is increasing in the western world resulting in a growing number of frail individuals with coronary heart disease, often associated with comorbidities. Decisions to proceed to invasive interventions in elderly frail patients is challenging because they may gain benefit, but are also at risk of procedure-related complications. Current risk scores designed to predict mortality in cardiac procedures are mainly based on clinical and angiographic factors, with limitations in the elderly because they are mainly derived from a middle-aged population, do not account for frailty and do not predict the impact of the procedure on quality of life which often matters more to elderly patients than mortality. Frailty assessment has emerged as a measure of biological age that correlates well with quality of life, hospital admissions and mortality. Potentially, the incorporation of frailty into current risk assessment models will cause a shift towards more appropriate care. The need for a more accurate method of risk stratification incorporating frailty, particularly for elderly patients is pressing. This article reviews the association between frailty and cardiovascular disease, the impact of frailty on outcomes of cardiac interventions and suggests ways in which frailty assessment could be incorporated into cardiology clinical practice.

No MeSH data available.


Related in: MedlinePlus