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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: 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.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

Age versus predicted mortality in the EuroSCORE and New York percutaneous coronary intervention scores, with all other variables kept as normal.
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OPENHRT2013000033F3: Age versus predicted mortality in the EuroSCORE and New York percutaneous coronary intervention scores, with all other variables kept as normal.

Mentions: The highest in-hospital mortality rates following PCI are seen among elderly patients, however, overall mortality has decreased in recent years, with the largest absolute reduction seen in patients >80 years.45 These patients represent both high risk and high benefit, and the decision-making process should rely on accurate risk modelling incorporating frailty. Numerous risk stratification models for PCI and CABG have been developed, but they perform poorly in elderly patients with multiple comorbidities. Most current models of risk in the field of CVD are heavily weighted towards age. With all other variables used in the scores kept the same, risk continues to increase with age alone. Thus, an otherwise healthy 80-year-old individual has a significantly higher risk score than a 60 year-old, regardless of how healthy, independent or non-frail he or she is (figure 3). The presence of comorbidities is used as a surrogate of frailty. However, this neglects those that are frail without significant comorbidities. Additionally, overestimation of risk in the elderly non-frail can occur.


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)

Age versus predicted mortality in the EuroSCORE and New York percutaneous coronary intervention scores, with all other variables kept as normal.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

OPENHRT2013000033F3: Age versus predicted mortality in the EuroSCORE and New York percutaneous coronary intervention scores, with all other variables kept as normal.
Mentions: The highest in-hospital mortality rates following PCI are seen among elderly patients, however, overall mortality has decreased in recent years, with the largest absolute reduction seen in patients >80 years.45 These patients represent both high risk and high benefit, and the decision-making process should rely on accurate risk modelling incorporating frailty. Numerous risk stratification models for PCI and CABG have been developed, but they perform poorly in elderly patients with multiple comorbidities. Most current models of risk in the field of CVD are heavily weighted towards age. With all other variables used in the scores kept the same, risk continues to increase with age alone. Thus, an otherwise healthy 80-year-old individual has a significantly higher risk score than a 60 year-old, regardless of how healthy, independent or non-frail he or she is (figure 3). The presence of comorbidities is used as a surrogate of frailty. However, this neglects those that are frail without significant comorbidities. Additionally, overestimation of risk in the elderly non-frail can occur.

Bottom Line: 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.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