衰弱与心血管疾病

老年慢性心力衰竭患者的营养不良发生率高，严重影响患者生命健康及生活质量，本文主要从老年慢性心力衰竭患者营养现状及其影响因素进行综述，以期对我国老年慢性心力衰竭患者早期营养不良进行识别，对潜在危险因素进行管理；提高老年慢性心力衰竭患者的生存质量。

在心血管疾病高发的背景下，本文围绕心力衰竭合并心律失常这一临床复杂病症，通过梳理近年来国内外相关研究文献，对心力衰竭合并心律失常的相关治疗进行综述，详细总结了当前的相关治疗策略的应用现状与进展。期望能为临床优化心力衰竭合并心律失常的相关治疗方案提供参考依据，进而改善患者预后、降低再住院率和死亡率。

应激性心肌病(stress cardiomyopathy, SC)，又称为Takotsubo综合征，最早于1990年由日本佐藤等人提出，是一种以急性一过性左心室收缩功能障碍为特征的疾病，好发于老年女性。其临床表现与急性心肌梗死类似，支持性和对症药物治疗仍然是主要疗法。目前其可能的病理生理机制包括交感神经系统过度刺激、中枢神经系统的结构和功能改变、儿茶酚胺分泌、炎症反应、微血管功能障碍等。虽然以前认为这是一种良性的自限性疾病，但近期的研究表明，尽管左心室射血分数恢复正常，但许多人仍然有限制性症状。近年来SC的确诊率也在不断提高，备受国内外专家关注。本文将从流行病学、触发因素、病理生理学、临床特征、诊断标准、治疗、预后方面对该病进行综述，以提高临床对SC的认识。

慢性心力衰竭(chronic heart failure, CHF)是多种心血管疾病的终末阶段，随着社会老龄化趋势，心衰的伤残调整生命年及医疗负担逐渐加重。在慢性心力衰竭病机中，线粒体功能障碍的作用日渐凸显，它不仅降低心肌细胞能量供应，也能诱发氧化应激导致的心肌细胞凋亡。中医学认为，脾气虚弱，气血乏源，心失所养可致慢性心衰；脾失运化，水湿内停，上犯凌心，亦可致心衰。总结发现“中医脾”与线粒体在概念、作用范围、功能特点方面有诸多联系。基于此，本文以“中医脾–线粒体”理论为切入点，分别从宏观、微观角度阐述脾虚在慢性心衰发展中的作用，提出用益气健脾法治疗心衰之本，以期为慢性心力衰竭的治疗提供理论支持，并为中医理论阐释线粒体功能障碍促进慢性心衰进展机制的现代研究奠定基础。

本文首先基于Cox生存模型和多种机器学习方法来构建心衰患者的生存预测模型，通过正则化方法识别出对心衰疾病具有重要影响的生物标记特征，并对所构建的五种生存预测模型的预测效果进行了比较分析，发现Cox回归模型和随机森林方法对心衰患者的生存预测效果是最为显著的。考虑到合理的用药策略不仅能够改善患者的结局，还能减轻患者的经济负担，因此本文将识别出的与心衰患者生存时间最为相关的五个风险因素进行了特征排名，依据单变量检验法和机器学习算法的排序结果确定出最为关键的两个特征指标，分别是射血分数和血清肌酐，进而通过构建Markov模型来比较和评估调节射血分数的药物的治疗效果和经济效用。总而言之，人工智能与医疗大数据的不断融合与创新为精准预测心衰患者的生存风险和精准识别影响心衰疾病的关键生物指标提供了可能，结合长期用药带来的经济负担，这些识别出的关键生物指标能为用药策略或治疗策略的制定提供有效的指导。

衰弱在心力衰竭患者中呈高发病率，并伴随高不良结局风险。炎症、肌少症和神经激素失调等促成因素会耗损生理储备并加速健康状况恶化，因而需采用多学科方法管理来满足身体、营养和药理学需求。饮食支持和结构化运动可以改善身体机能，而谨慎的药物管理可以降低与衰弱相关的风险。远程医疗和可穿戴技术有助于持续监控和及时干预。未来研究方向应旨在研发标准化衰弱评估工具及新疗法，强化风险分层和个性化护理。解决社会经济因素也可以提高护理公平性。本综述总结了衰弱对心力衰竭的机制、临床特征、治疗挑战和预后影响。

As global aging accelerates, frailty and depressive symptoms have emerged as critical contributors to cardiovascular disease (CVD) risk among older adults. However, the dynamic interplay between these factors remains underexplored. Here, we examine the associations among frailty, depressive symptoms, and incident CVD using data from five international cohorts (HRS, CHARLS, SHARE, ELSA, MHAS) involving individuals aged 50 and above. Our findings reveal that frailty significantly increases CVD risk, with depressive symptoms partially mediating this relationship. Transitions into frailty elevate CVD risk, while improvements reduce it. Cross-lagged panel network analysis identifies consistent CVD predictors, including hypertension, diabetes, and mobility issues. Subgroups with stronger associations include frail males, older individuals, working or retired people, and those with unhealthy lifestyles. These results underscore the need for integrated interventions targeting frailty and depressive symptoms to prevent CVD in aging populations. Global aging emphasizes the exploration of frailty and depression in relation to incident CVD in middle-aged and older adults. Here, the authors show that frailty is associated with increased CVD risk, partially through depression, with the association influenced by frailty transitions and stronger in males, the elderly, and those with unhealthy lifestyles.

The triglyceride-glucose (TyG) index is a validated surrogate for insulin resistance, while frailty reflects cumulative physiological decline. The combined impact of TyG-Frailty Index (TyGFI) has not been adequately explored. This study aimed to investigate the association between TyGFI and the risk of cardiovascular disease (CVD) and stroke. A total of 5448 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 1139 participants from the U.S. National Health and Nutrition Examination Survey (NHANES) were included. Multivariable logistic regression models were used to estimate associations with CVD and stroke, adjusting for demographic, clinical, and lifestyle covariates. Restricted cubic spline (RCS) and subgroup analyses were employed to examine dose–response relationships and interaction effects. Higher TyGFI levels were associated with older age, adverse metabolic parameters, and increased prevalence of hypertension, diabetes, and dyslipidemia. In fully adjusted models, the highest TyGFI quartile was significantly associated with increased risks of CVD (CHARLS: OR 15.09, 95% CI 9.65–23.60; NHANES: OR 4.98, 95% CI 2.04–12.19) and stroke (CHARLS: OR 21.12, 95% CI 6.44–69.23; NHANES: OR 12.98, 95% CI 2.58–65.17), with consistent dose–response trends confirmed by RCS analyses. Subgroup analyses further demonstrated the robustness of these associations across diverse demographic and clinical strata. TyGFI is a strong and independent predictor of CVD and stroke in two nationally representative cohorts. By integrating metabolic and functional risk dimensions, TyGFI provides a more comprehensive risk stratification tool, with significant implications for early identification and prevention of cardiovascular events in aging populations.

BACKGROUND AND AIMS Previous studies found that frailty was an important risk factor for cardiovascular disease (CVD). However, previous studies only focused on baseline frailty status, not taking into consideration the changes in frailty status during follow-up. The aim of this study was to investigate the associations of changes in frailty status with incident CVD. METHODS This study used data of three prospective cohorts: China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), and Health and Retirement Study (HRS). Frailty status was evaluated by the Rockwood frailty index and classified as robust, pre-frail, or frail. Changes in frailty status were assessed by frailty status at baseline and the second survey which was two years after the baseline. Cardiovascular disease was ascertained by self-reported physician-diagnosed heart disease (including angina, heart attack, congestive heart failure, and other heart problems) or stroke. Cox proportional hazard models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) after adjusting for potential confounders. RESULTS A total of 7116 participants from CHARLS (female: 48.6%, mean age: 57.4 years), 5303 from ELSA (female: 57.7%, mean age: 63.7 years), and 7266 from HRS (female: 64.9%, mean age: 65.1 years) were included according to inclusion and exclusion criteria. The median follow-up periods were 5.0 years in the CHARLS, 10.7 years in the ELSA, and 9.5 years in the HRS. Compared with stable robust participants, robust participants who progressed to pre-frail or frail status had increased risks of incident CVD (CHARLS, HR = 1.84, 95% CI: 1.54-2.21; ELSA, HR = 1.53, 95% CI: 1.25-1.86; HRS, HR = 1.59, 95% CI: 1.31-1.92). In contrast, frail participants who recovered to robust or pre-frail status presented decreased risks of incident CVD (CHARLS, HR = 0.62, 95% CI: 0.47-0.81; ELSA, HR = 0.49, 95% CI: 0.34-0.69; HRS, HR = 0.70, 95% CI: 0.55-0.89) when compared with stable frail participants. These decreased risks of incident CVD were also observed in pre-frail participants who recovered to robust status (CHARLS, HR = 0.66, 95% CI: 0.52-0.83; ELSA, HR = 0.65, 95% CI: 0.49-0.85; HRS, HR = 0.71, 95% CI: 0.56-0.91) when compared with stable pre-frail participants. CONCLUSIONS Different changes in frailty status are associated with different risks of incident CVD. Progression of frailty status increases incident CVD risks, while recovery of frailty status decreases incident CVD risks.

This study aimed to investigate the complex associations of frailty and high-sensitivity C-reactive protein (hsCRP) with cardiovascular disease (CVD) through a nationwide prospective cohort, while also assessing the mediating associations. According to critical criteria, a total of 5239 participants from the China Health and Retirement Longitudinal Study (CHARLS) in 2011 were ultimately enrolled in this study. Frailty was evaluated by the frailty index with 40 items, and CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. A restricted cubic spline model, receiver operating characteristic curves, adjusted Cox proportional hazards regression, interaction analyses and mediation analyses were performed for association exploration. During a maximum follow-up of 7.0 years, 1204 (23.67%) people developed CVD. Both elevated hsCRP and frailty were significantly associated with CVD incidence. Compared with participants with a healthy status and low hsCRP (< 1.015 mg/L), those with a frailty status and elevated hsCRP had the highest risk of CVD (adjusted HR, 2.97; 95% CI 2.29–3.84), heart disease (adjusted HR, 2.93; 95% CI 2.16–3.96), and stroke (adjusted HR, 4.26; 95% CI 2.81–6.44), which were still robust in the subgroup analysis. Moreover, frailty significantly mediated 19.60% of the associations between hsCRP and CVD. Combined assessment of frailty and hsCRP levels helps to better stratify the individual risk of CVD. Frailty could partly mediate the associations between hsCRP and CVD incidence.

Frailty and inflammation may increase the risk of cardiovascular disease (CVD), but their interacting and joint effects on CVDs remain unclear. To explore the interaction effects of frailty and inflammation on CVDs and the role of inflammation in the relationship between frailty and CVDs to provide better understanding of the underlying pathogenesis of CVD. A total of 220,608 initially CVD-free participants were recruited from the UK Biobank database and were categorized into non-frailty, pre-frailty, and frailty groups based on Fried’s criteria. The participants were also grouped according to the low-grade inflammation (INFLA) score and its components: the neutrophil-lymphocyte ratio, C-reactive protein, white blood cell count, and platelet count. Cox proportional hazards models with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to assess the effects of frailty phenotypes and inflammation on CVD risk. Mediation analysis was used to quantify the role of inflammation in the association between frailty and CVDs. The potential interactions between frailty and inflammation in terms of CVD risk were also evaluated using additive and multiplicative scales. During a median follow-up of 13.3 years, 48,978 participants developed CVDs. After adjusting for various confounders, participants with pre-frailty and frailty had a higher risk of CVDs than those with non-frailty (HRs: 1.20 (95% CI: 1.18–1.23) and 1.80 (95% CI: 1.69–1.91), respectively). A higher risk of CVDs was observed among participants with moderate and high INFLA scores than those with low INFLA scores (HRs: 1.09 (95% CI: 1.07–1.12) and 1.27 (95% CI: 1.24–1.30), respectively). The INFLA score and its components had limited mediating effects in the association between frailty and CVDs. Significant interactions were observed between frailty phenotypes and INFLA scores on CVDs on the multiplicative scale but not on the additive scale. Inflammation may amplify the harmful effect of frailty on the incidence of CVDs. Improving frailty alone might not substantially reduce the risk of CVDs, but effectively controlling inflammation might help to reduce the negative effects of frailty on cardiovascular health.

Frailty is an inevitable part of ageing, which is also associated with a variety of chronic diseases, the most common of which are cardiovascular diseases. The WHO non-laboratory-based CVD risk scores are reliable predictors of cardiovascular events and are used in treatment decision-making in primary health-care settings. The current study aims to find the association between the non-laboratory-based CVD risk scores and frailty scores. The association between frailty and CVD risk scores of 56,450 older adults was estimated using nationally representative survey (Longitudinal Aging Study in India -LASI-1st Wave). Separate multivariable logistic regression was performed after adjusting for socio-economic, demographic and health related variables. Restricted cubic splines were also estimated to explore the association between probability of frailty and non-lab-based CVD risk score. The mean age of the participants was 59.3 ± 10.3 years. The prevalence of frailty was 15.6% in the participants above 45 years and 25.5% among participants aged more than 60 years. There was a significant association between the CVD risk scores and frailty in the participants and an increasing trend across the age groups (aOR = 1.3 (1.1–1.4), 2.3 (1.1–2.6), 3.6 (3.1–4.2) and 5.0 (2.9–8.6)) for CVD scores of 5–9, 10–19, 20–29 and > 30 respectively compared to a CVD risk score of < 5. The strength of association of frailty with CVD risk score when adjusted for both socioeconomic, demographic and health variables (model 2), was greater for females and ≥ 60 years age groups (aOR = 19.9 (CVD score > 30) and 4.6 (CVD score 20–29), respectively). Screening for frailty should be performed in individuals with high non-laboratory-based CVD risk scores as a method of primary prevention to plan targeted interventions as a form of secondary prevention with more focusing on females and ≥ 60 years elderly population.

Insulin resistance and diabetes are associated with an increased risk of frailty, and frailty is associated with cardiovascular disease and premature mortality. We aim to investigate the impact of long‐term insulin resistance trajectories on future frailty and cardiovascular risk among young adults.

Background This study aimed to create a deep learning model for predicting phenotypic physical frailty from electronic medical record information in patients with cardiovascular disease. Methods and Results This single-center retrospective study enrolled patients who could be assessed for physical frailty according to cardiovascular health study criteria (25.5% [691/2,705] of the patients were frail). Patients were randomly separated for training (Train set: 80%) and validation (Test set: 20%) of the deep learning model. Multiple models were created using LightGBM, random forest, and logistic regression for deep learning, and their predictive abilities were compared. The LightGBM model had the highest accuracy (in a Test set: F1 score 0.561; accuracy 0.726; area under the curve of the receiver operating characteristics [AUC] 0.804). These results using only commonly used blood biochemistry test indices (in a Test set: F1 score 0.551; accuracy 0.721; AUC 0.793) were similar. The created models were consistently and strongly associated with physical functions at hospital discharge, all-cause death, and heart failure-related readmission. Conclusions Deep learning models derived from large sample sizes of phenotypic physical frailty have shown good accuracy and consistent associations with prognosis and physical functions.

The prevalence of the cognitive frailty is increasing in China. Screening for this condition is crucial for its early detection, prevention, and treatment. This study was designed to explore the incidence of cognitive frailty among hospitalized elderly patients suffering from cardiovascular disease. It also aimed to analyze the factors influencing its occurrence, thereby providing substantial evidence for the development of early prevention and intervention strategies. From March 2022 to October 2023, under cardiovascular care program, the cardiovascular patients (n = 1190) were subjected to standardized questionnaires to collect demographical characteristics. Also, nutritional and psychosocial assessments tests were performed for the enrolled patients. Multivariate logistic regression analysis was used to evaluate factors associated with cognitive frailty. A total of 1190 (755 males and 435 females) were included. The mean age was 73.36 ± 7.37 years. The prevalence of cognitive frailty in the study population was 33.9% (404/1190). The prevalence of cognitive frailty was 40.7% in men, 22.3% in women. In terms of specific cardiovascular diseases, the prevalence of cognitive frailty was 28.5% in coronary heart disease, 20.5% in arrhythmia, 36.8% in valvular disease, 53% in heart failure, and 13.7% in hypertension. The multivariable analysis showed that age (OR = 1.13, 95% CI: 1.10–1.15, P < .001), anxiety (OR = 1.01, 95% CI: 1.03–1.11, P = .001), female sex (OR = 1.83, 95% CI: 1.10–1.16, P < .001), education level (college and above, OR = 0.27, OR = 0.12–0.64, P = .003), polypharmacy (OR = 2.29, 95% CI: 1.62–3.23, P < .001), comorbidity (OR = 1.93 95% CI: 1.37–2.71, P < .010), region (rural, OR = 1.77, 95% CI: 1.36–2.30, P < .001), sarcopenia (OR = 1.60, 95% CI: 1.16–2.19, P = .004), and nutritional status (risk of malnutrition, OR = 1.66, 95% CI: 1.17–2.35, P = .004; malnutrition exists, OR = 3.24, 95% CI: 1.85–5.83, P < .001) were independently associated with cognitive frailty. The prevalence of cognitive frailty was 33.9% in hospitalized elderly cardiovascular patients in Guangzhou. heart failure, hypertension, age, anxiety, female sex, education level, polypharmacy, comorbidity, region, sarcopenia, and nutritional status were independent risk factors for cognitive frailty.

Frailty is a syndrome of older age that reflects an impaired physiological reserve and decreased ability to recover from medical stressors. While the impact of frailty on mortality in cardiovascular disease has been well described, its impact on cardiovascular disease–specific health status—cardiac symptoms, physical functioning and quality of life—has been less well studied. In this review, we summarise the impact of frailty on health status outcomes across different cardiovascular conditions. In heart failure, frail patients have markedly impaired disease-specific health status and are at risk for subsequent health status deteriorations. However, frail patients have similar or even greater health status improvements with interventions for heart failure, such as cardiac rehabilitation or guideline-directed medical therapy. In valvular heart disease, the impact of frailty on disease-specific health status is of even greater concern since management involves physiologically taxing procedures that can worsen health status. Frailty increases the risk of poor health status outcomes after transcatheter aortic valve intervention or surgical aortic valve replacement for aortic stenosis, but there is no evidence that frail patients benefit more from one procedure versus another. In both heart failure and valvular heart disease, health status improvements may reverse frailty, highlighting the overlap between cardiovascular disease and frailty and emphasising that treatment should typically not be withheld based on the presence of frailty alone. Meanwhile, data are limited on the impact of frailty on health status outcomes in the treatment of coronary artery disease, peripheral artery disease and atrial fibrillation, and requires further research.

BACKGROUND Whether frailty influences the initiation of two cardioprotective diabetes drug therapies (ie, SGLT2 inhibitors and GLP-1 receptor agonists) in people with type 2 diabetes and cardiovascular disease is unknown. We aimed to assess rates of initiation of SGLT2 inhibitors and GLP-1 receptor agonists according to frailty in people with type 2 diabetes and cardiovascular disease. METHODS For this cross-sectional, nationwide study, all people with type 2 diabetes and cardiovascular disease in Denmark between Jan 1, 2015, and Dec 31, 2021, from six Danish health-data registers were identified. People younger than 40 years, with end-stage renal disease, with registered contraindications to SGLT2 inhibitors or GLP-1 receptor agonists, or with previous use of either drug therapy were excluded. The Hospital Frailty Risk Score was used to categorise people as either non-frail, moderately frail, or severely frail. Cox proportional hazards models were used to analyse the association between frailty and initiation of an SGLT2 inhibitor or a GLP-1 receptor agonist. FINDINGS Of 119 390 people with type 2 diabetes and cardiovascular disease, 103 790 were included. Median follow-up time was 4·5 years (IQR 2·7-6·1) and median age across the three frailty groups was 71 years (64-79). 65 959 (63·6%) of 103 790 people were male and 37 831 (36·5%) were female. At index date, 66 910 (64·5%) people were non-frail, 29 250 (28·2%) were moderately frail, and 7630 (7·4%) were severely frail. Frailty was associated with a significantly lower probability of initiating therapy with an SGLT2 inhibitor or a GLP-1 receptor agonist than in people who were non-frail (moderately frail hazard ratio 0·91, 95% CI 0·88-0·94, p<0·0001; severely frail 0·75, 0·70-0·80, p<0·0001). This association persisted after adjustment for age, sex, socioeconomic status, year of inclusion, duration of type 2 diabetes, duration of cardiovascular disease, polypharmacy, and comorbidity. INTERPRETATION In people with type 2 diabetes and cardiovascular disease in Denmark, frailty was associated with a significantly lower probability of SGLT2-inhibitor or GLP-1 receptor-agonist initiation, despite their benefits. Formulating clear and updated guidelines on the use of SGLT2 inhibitors and GLP-1 receptor agonists in people who are frail with type 2 diabetes and cardiovascular disease should be a priority. FUNDING Department of Cardiology, Herlev and Gentofte University Hospital. TRANSLATION For the Danish translation of the abstract see Supplementary Materials section.

BACKGROUND AND AIM Observational studies have suggested a relationship between frailty and cardiovascular disease (CVD), but the causality is still uncertain. We used bidirectional Mendelian randomization (MR) design to investigate the potential causal associations between frailty and four main CVDs, including hypertension, myocardial infarction (MI), heart failure (HF), and atrial fibrillation (AF). METHODS AND RESULTS Independent single-nucleotide polymorphisms for frailty index (FI) and CVDs (hypertension, MI, HF, and AF) were selected as genetic instruments based on European-descent genome-wide association studies (GWASs). Summary-level data for outcomes on FI (n = 175,226), hypertension (n = 463,010), MI (n = 171,875), HF (n = 977323), and AF (n = 1,030,836) was derived from five large-scale GWASs of European ancestry. We used the inverse-variance weighted (IVW) method to examine the bidirectional associations between FI and CVDs in the main analyses. In the IVW MR analyses, genetically determined high FI was significantly associated with increased risks of hypertension (odds ratio [OR] per 1-SD increase: 1.07 [95 % confidence interval, 1.05-1.08]), MI (OR per 1-SD increase: 1.74 [1.21-2.51]), HF (OR per 1-SD increase: 1.28 [1.10-1.48]), and AF (OR per 1-SD increase: 1.20 [1.08-1.33]). In addition, genetically determined hypertension (beta: 1.406 [1.225-1.587]), MI (beta: 0.045 [0.023-0.067]), HF (beta: 0.105 [0.066-0.143]) and AF (beta: 0.021 [0.012-0.031]) were significantly associated with high FI. These findings were robustly supported by a series of sensitivity analyses with different MR models. CONCLUSIONS We found potential bidirectional causal associations between elevated FI and increased risks of CVD, suggesting mutual risk factors between frailty and CVD.

Study objective This study examined the association between frailty and incident cardiovascular disease (CVD) events, major adverse cardiovascular events (MACE), and CVD-related mortality. Design Longitudinal cohort study. Setting The ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial in Australia and the United States. Participants 19,114 community-dwelling older adults (median age 74.0 years; 56.4 % females). Interventions Pre-frailty and frailty were assessed using a modified Fried phenotype and a deficit accumulation Frailty Index (FI) at baseline. Main outcome measures CVD was defined as a composite of CVD death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for heart failure; MACE included all except heart failure. Cox proportional hazards regression was used to analyze the association between frailty and CVD outcomes over a median follow-up of 4.7 years. Results Baseline pre-frail and frail groups had a higher risk of incident CVD events (Hazard Ratio (HR): 1.31; 95 % Confidence Interval (CI): 1.14–1.50 for pre-frail and HR: 1.63; 95 % CI: 1.15–2.32 for frail) and MACE (pre-frail HR: 1.26; 95 % CI: 1.08–1.47 and frail HR: 1.51; 95 % CI: 1.00–2.29) than non-frail participants according to Fried phenotype after adjusting for traditional CVD risk factors. Effect sizes were similar or larger when frailty was assessed with FI; similar results for men and women. Conclusion Frailty increases the likelihood of developing CVD, including MACE, in community-dwelling older men and women without prior CVD events. Screening for frailty using Fried or FI method could help identify community-dwelling older adults without prior CVD events who are more likely to develop CVD, including MACE, and may facilitate targeted preventive measures to reduce their risk.

Background Frailty and cognitive impairment (CI) are geriatric conditions that lead to poor health outcomes among older adults with cardiovascular disease. The association between their temporal patterns of development and cardiovascular risk is unknown. Objectives This study aims to examine the 5-year cardiovascular outcomes by the pattern of development of frailty and CI in older adults without a history of coronary artery disease. Methods We used the National Health and Aging Trends Study, linked to Medicare data. Frailty was measured using the physical frailty phenotype. CI was measured using the AD8 Dementia Screening Interview, measured cognitive performance, or self-report by patient or caregiver for a diagnosis given by a physician. The primary outcome was incident major adverse cardiovascular event at 5 years. Results Of a total 2,189 study participants aged 65 and older, 38.5% were male. In this study population, 154 (7%) participants developed frailty first, 829 (38%) developed CI first, and 195 (9%) participants developed both simultaneously (frail-CI group). Those who developed frailty and CI simultaneously were older, more likely to be female, and had multiple chronic conditions. The frail-CI group had the highest risk of major adverse cardiovascular event (hazard ratio [HR]: 1.81; 95% CI: 1.47–2.23) followed by frail first (HR: 1.46; 95% CI: 1.17–1.81) and CI first (HR: 1.31; 95% CI: 1.15–1.50). Frailty first was associated with the greater risk of stroke (HR: 1.49; 95% CI: 1.06–2.09) compared to the intact group. Conclusions The simultaneous development of frailty and CI is associated with an increased risk of adverse cardiovascular outcomes including death compared with the development of each syndrome alone. Diagnostics to detect frailty and CI are critical in assessment of cardiovascular risk in the older population.

Objectives Previous studies had reported that frailty and loneliness were associated with increased risk of cardiovascular disease (CVD). The aim of present study was to evaluate the combined effect of frailty and loneliness on the risk of CVD. Methods A total of 9,674 participants from the China Health and Retirement Longitudinal Study were included. Multivariate Cox proportional hazards regression model was used to explore the associations between frailty, loneliness and new-onset CVD, stroke and cardiac events. Results During the 7-year follow-up, a total of 1,758 respondents experienced CVD (including 584 stroke and 1,324 cardiac events). Compared to those without loneliness or frailty, individuals with loneliness alone, or with frailty alone, or with both loneliness and frailty were significantly associated with increased risk of CVD, with corresponding HRs (95%CIs) were 1.21(1.07–1.37), 1.57(1.32–1.86) and 1.78(1.52–2.10), respectively. Similarly, participants with loneliness alone, or with frailty alone, or with both loneliness and frailty were associated with higher risk of cardiac events. The significant associations were consistent in age subgroups (participants aged less or more than 60 years). Conclusion Our study indicated that there was a combined effect of effect of frailty and loneliness on the risk of CVD, stroke and cardiac events. These findings highlighted the importance of identifying loneliness and frailty, and intervening much earlier both in older and younger population.

AIMS To investigate the impacts of frailty on the progression of prediabetes to diabetes, cardiovascular disease (CVD) and all-cause mortality in individuals with prediabetes and diabetes. METHODS 7,933 subjects with prediabetes and diabetes were included from the China Health and Retirement Longitudinal Study (CHARLS) and English Longitudinal Study of Ageing (ELSA). Frailty status was assessed by frailty index and classified as robust, pre-frail, and frail. Logistic regression was used to calculate risks of progression to diabetes. Cox regression was used to calculate risks of CVD and all-cause mortality. RESULTS In prediabetes, frail subjects had significantly increased risks of progression to diabetes (CHARLS, OR=1.55, 95%CI: 1.09-2.20; ELSA, OR=1.86, 95%CI: 1.02-3.37) compared with robust subjects. Frail subjects with prediabetes also presented significantly increased risks of CVD (CHARLS: HR=1.90, 95%CI: 1.45-2.48; ELSA: HR=1.94, 95%CI: 1.31-2.88) and all-cause mortality (CHARLS: HR=2.45, 95%CI: 1.79-3.36; ELSA: HR=2.13, 95%CI: 1.46-3.10) than robust subjects with prediabetes. In diabetes, frailty still increased risks of CVD (CHARLS, HR=2.72, 95%CI: 1.97-3.77; ELSA, HR=2.41, 95%CI: 1.43-4.06) and all-cause mortality (CHARLS, HR=2.28, 95%CI: 1.56-3.33; ELSA, HR=2.28, 95%CI: 1.47-3.53). CONCLUSIONS Frailty is associated with the progression of prediabetes to diabetes and elevated risks of CVD and all-cause mortality in individuals with prediabetes and diabetes.

Data are limited about the contemporary association between frailty and the causes and outcomes of patients admitted with cardiovascular diseases (CVD). Using the US National Inpatient Sample, CVD admissions of interest (acute myocardial infarction, ischemic stroke, atrial fibrillation (AF), heart failure, pulmonary embolism, cardiac arrest, and hemorrhagic stroke) were stratified by Hospital Frailty Risk Score (HFRS). Logistic regression was used to determine adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of in-hospital mortality among different groups with frailty. The study included 9,317,398 hospitalizations. Of these, 5,573,033 (59.8%) had a low HFRS (<5); 3,422,700 (36.7%) had an intermediate HFRS (5 to 15); and 321,665 (3.5%) had a high HFRS (>15). Ischemic stroke was the most common admission for the groups with high risk (75.4%), whereas acute myocardial infarction was the most common admission for the group with low risk (36.9%). Compared with the group with low risk, patients with high risk had increased mortality across the most CVD admissions, except in patients admitted for cardiac arrest and hemorrhagic stroke (p <0.001). The strongest association with all-cause mortality was shown among patients with high risk admitted for AF (aOR 6.75, 95% CI 6.51 to 7.00, and aOR 17.69, 95% CI 16.08 to 19.45) compared with their counterparts with low risk. In conclusion, patients with CVD admissions have varying frailty risk according to cardiovascular cause of admission, with ischemic stroke being the most common among groups with frailty and high risk. Increased frailty is associated with all-cause mortality in patients with most CVD admissions, except for cardiac arrest and hemorrhagic stroke, with the strongest association seen in patients admitted with AF.

Frailty indicates a decline in biological reserve and resistance to stressors, resulting in vulnerability to adverse outcomes1) in the physical, psychological, and social domains. Frailty, especially physical frailty, is associated with an increased risk of adverse health outcomes, which can significantly impact life expectancy in the elderly population. Recently, frailty has been reported to be associated with an increased risk of cardiovascular disease (CVD) incidence or death in older adults in several countries, including Japan2-4). In addition, a previous report showed that weak handgrip strength, a component of phenotypic frailty, was associated with all-cause and CVD death in Japanese older adults5). Furthermore, Tobe and colleagues reported that handgrip strength was inversely associated with the composite endpoint of all-cause death, the incidence of myocardial infarction, and readmission due to heart failure in Japanese older adults who underwent percutaneous coronary intervention6). These findings indicate the importance of frailty management for CVD prevention in Japanese older adults. Several mechanisms have been proposed for the relationship between frailty and CVD2, 7). Frailty is strongly associated with multimorbidity, including subclinical atherosclerotic diseases, hypertension, and diabetes, and these comorbidities may contribute to the increased risk of CVD in frail populations. A previous report showed that frailty was associated with poor lifestyle habits that affect cardiovascular health, and lifestyle modification may reduce CVD risk in frail and pre-frail populations7). In addition, the pathophysiological mechanisms underlying frailty and CVD include chronic inflammation, increased insulin resistance, and endocrine dysregulations, which may confound the association between frailty and CVD. Furthermore, changes in the morphology and function of the vascular system associated with aging may lead to a decline in brain and muscle function, resulting in frailty progression and CVD development. However, the mechanism through which frailty contributes to CVD development remains unclear, and further research is needed to elucidate this mechanism. Several factors should be considered in the interpretation of the results of observational studies examining the association between frailty and CVD incidence or death. First, definitions of frailty and the scales used to measure frailty vary among studies. A commonly used criterion is the criterion for phenotypic frailty proposed by Fried and colleagues, which was validated based on the Cardiovascular Health Study1). This criterion consists of five items: weakness assessed by grip strength, slowness from usual gait speed, exhaustion derived from a selfreported fatigue questionnaire, low activity based on estimated energy expenditure calculated from a physical activity questionnaire, and unintentional weight loss, with phenotypic frailty being confirmed when three of the five items are met. This criterion considers frailty as a biological syndrome due to the decrease in the physiological reserve and represents the physical aspect of frailty. Another commonly used criterion for frailty is the frailty index developed by Rockwood and colleagues using data from the Canadian Study of Health and Aging, which studied the cumulative effect of medical, functional, and psychosocial age-related deficits8). The frailty index considers frailty as a spectrum of aging and is suitable for frailty management. Several scales have been developed to assess frailty, including the revised Japanese version of the Cardiovascular Health Study (J-CHS) criteria and the Kihon Checklist. Results should be interpreted based on an accurate understanding of the concepts used in such scales. Second, definitions of CVD differ among studies. For

Background Prospective cohort studies suggest that frailty is associated with an increased risk of incident cardiovascular disease (CVD) morbidity and mortality, but their mechanistic and developmental relations are not fully understood. We investigated whether frailty predicted an increased risk of incident nonfatal and fatal CVD among community-dwelling older adults. Methods A population cohort of 5015 participants aged 55 years and above free of CVD at baseline was followed for up to 10 years. Pre-frailty and frailty were defined as the presence of 1–2 and 3–5 modified Fried criteria (unintentional weight loss, weakness, slow gait speed, exhaustion, and low physical activity), incident CVD events as newly diagnosed registered cases of myocardial infarction (MI), stroke, and CVD-related mortality (ICD 9: 390 to 459 or ICD-10: I00 to I99). Covariate measures included traditional cardio-metabolic and vascular risk factors, medication therapies, Geriatric Depression Scale (GDS), Mini-Mental State Exam (MMSE), and blood biomarkers (haemoglobin, albumin, white blood cell counts and creatinine). Results Pre-frailty and frailty were significantly associated with elevated HR = 1.26 (95%CI: 1.02–1.56) and HR = 1.54 (95%CI:1.00–2.35) of overall CVD, adjusted for cardio-metabolic and vascular risk factors and medication therapies, but not after adjustment for GDS depression and MMSE cognitive impairment. The HR of association between frailty status and both CVD mortality and overall mortality, however, remained significantly elevated after full adjustment for depression, cognitive and blood biomarkers. Conclusion Frailty was associated with increased risk of CVD morbidity and especially mortality, mediated in parts by traditional cardio-metabolic and vascular risk factors, and co-morbid depression and associated cognitive impairment and chronic inflammation. Given that pre-frailty and frailty are reversible by multi-domain lifestyle and health interventions, there is potential benefits in reducing cardiovascular diseases burden and mortality from interventions targeting pre-frailty and early frailty population.

Frailty has been associated with poor outcomes in patients with cardiovascular diseases (CVDs). We aimed to assess the accuracy of the Eyeball test for frailty assessment in elderly patients with CVD. This is a prospective study including stable patients ≥75 years old who were followed-up in a cardiology clinic. Frailty assessment was performed separately through the Eyeball test and the Fried test in a blinded way. Cardiologists were asked to rate the frailty status of participants based on their routine clinical assessment and grade frailty on a Fried-type scale (1 to 5, with frailty defined as a score ≥3). Each patient then underwent formal frailty assessment using the Fried test. Included were 300 consecutive patients with a mean age of 81 ± 6 years. Frailty was diagnosed in 109 (36%) and 125 patients (41%) according to the Fried and Eyeball tests, respectively. The Eyeball test demonstrated 86% sensitivity and 82% specificity for the diagnosis of frailty. A receiver operating characteristics curve analysis demonstrated an area under the curve of 0.82 for the diagnosis of frailty. The Eyeball test demonstrated a very high negative predictive value of 90% and a modest positive predictive value of 73% for frailty assessment. Similar results were observed after subgroup analysis according to age and gender. In conclusion, the Eyeball test is an accurate method to rule out frailty in elderly patients with CVD. However, when frailty is suspected based on the Eyeball test, a formal tool such as the Fried test should be used to confirm the diagnosis.

Data are limited on whether the causes of emergency department (ED) encounters for cardiovascular diseases (CVDs) and associated clinical outcomes vary by frailty status. Using the United States Nationwide ED Sample, selected CVD encounters (acute myocardial infarction [AMI], ischemic stroke, atrial fibrillation [AF], heart failure [HF], pulmonary embolism, cardiac arrest, and hemorrhagic stroke) were stratified by hospital frailty risk score (HFRS). Logistic regression was used to determine the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of ED mortality among the different frailty groups. A total of 8,577,028 selected CVD ED encounters were included. A total of 5,120,843 (59.7%) had a low HFRS (<5), 3,041,699 (35.5%) had an intermediate HFRS (5 to 15), and 414,485 (4.8%) had a high HFRS (>15). Ischemic stroke was the most common reason for the encounter in the high HFRS group (66.9%), followed by hemorrhagic stroke (11.7%) and AMI (7.2%). For the low HFRS group, AF was the most common reason for the encounter (30.2%), followed by AMI (23.6%) and HF (16.8%). Compared with the low-risk group, high-risk patients had a decreased ED mortality and an increased overall mortality across most CVD encounters (p <0.001). The strongest association with overall mortality was observed among patients with a high HFRS admitted for AF (aOR 27.14, 95% CI 25.03 to 29.43) and HF (aOR 13.71, 95% CI 12.95 to 14.51) compared with their low-risk counterparts. In conclusion, patients presenting to the ED with acute CVD have a significant frailty burden, with different patterns of CVD according to frailty status. Frailty is associated with an increased all-cause mortality in patients for most CVD encounters.

This study aimed to identify factors associated with frailty in heart failure (HF) patients, focusing on demographic, biochemical and health‐related variables. It also explored the correlation between frailty and comorbidities such as malnutrition, cognitive impairment and depression, assessing how these factors interact to influence frailty risk.

Key Points Question Is finerenone, a nonsteroidal mineralocorticoid receptor antagonist, a safe and effective therapy in patients with heart failure (HF) with mildly reduced ejection fraction (HFmrEF) or HF with preserved ejection fraction (HFpEF), regardless of frailty status? Findings In this prespecified secondary analysis of patients with HFmrEF or HFpEF in the Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF), frailty was common, and greater frailty was associated with more impairment in health status and worse clinical outcomes, including worsening HF events, hospitalizations, and death. Compared with placebo, finerenone reduced the risk of worsening HF events and cardiovascular deaths and improved symptoms in patients with HFmrEF or HFpEF across the range of frailty studied. Meaning The favorable benefit-risk balance associated with frailty for finerenone should challenge any clinical reluctance to introduce this new treatment in patients considered to be frail.

The Heart Failure Frailty Score (HFFS) is a novel, multidimensional tool to assess frailty in patients with heart failure (HF). It has been developed to overcome limitations of existing frailty assessment tools while being practical for clinical use. The HFFS reflects the concept of frailty as a multidimensional, dynamic and potentially reversible state, which increases vulnerability to stressors and risk of poor outcomes in patients with HF.

AIM This study aimed to identify the heterogeneous trajectories of frailty and determine the predictors of distinct trajectories in patients with heart failure. DESIGN A longitudinal study. METHODS A total of 253 patients with heart failure were recruited at the cardiology department of a tertiary hospital between February and December 2023. Frailty was assessed at baseline, 1 and 4 months after discharge. Patients' sociodemographic characteristics, physical symptoms, nutritional status, psychological distress, illness perception and social networks were obtained at baseline using a structured questionnaire. Group-based trajectory modelling was performed to identify the heterogeneity of the trajectories of frailty. Multiple logistic regression and decision tree models were used to explore the predictors of heterogeneous trajectories of frailty. RESULTS Three distinct trajectories of frailty were identified in patients with heart failure: low frailty with high-degree improvement group (46.2%), moderate frailty with high-degree improvement group (41.1%) and high frailty with low-degree improvement group (12.6%). Multiple logistic regression analysis showed that physical symptoms, nutritional status, illness perception and employment status were entered as independent predictors of heterogeneous trajectories of frailty. The decision tree model demonstrated that physical symptoms were the primary predictors, followed by nutritional status, illness perception and psychological distress. CONCLUSIONS Three distinct categories of frailty trajectories were identified in patients with heart failure. Physical symptoms, nutritional status, psychological distress, illness perception and employment status were independent predictors of heterogeneous trajectories of frailty, with physical symptoms being the most important predictor. IMPLICATION TO CLINICAL PRACTICE Dynamic frailty assessment is recommended. Interventions aimed at alleviating physical symptoms, psychological distress and negative illness perception, and improving nutritional status may be conducive to delaying or reversing frailty in patients with heart failure, particularly in unemployed individuals. REPORTING METHOD The reporting followed the STROBE guideline. PATIENT OR PUBLIC CONTRIBUTIONS No patient or public contribution.

Background Heart failure (HF) and frailty often coexist. However, it is unknown how the interplay between HF and frailty at HF onset impacts prognosis of frail patients with HF and how this has evolved over time. Methods and Results We identified 131 235 patients with new‐onset HF (median age 74 years, 39.7% women) from Danish nationwide registers in 1999 to 2017. Stratification according to the Hospital Frailty Risk Score resulted in (1) 102 635 (78%) nonfrail, (2) 26 054 (20%) moderately frail, and (3) 2609 (2%) severely frail patients. The proportion of moderately frail patients increased from 13.2% to 24.9%. Five‐year absolute risks of all‐cause mortality, HF hospitalization, and non‐HF hospitalization were calculated using the Kaplan‐Meier and Aalen‐Johansen estimators. From 1999 to 2002 to 2003 to 2017, all‐cause mortality risk (95% CI) declined from 56.4% (55.8%–57.0%) to 33.3% (32.6%–34.1%), 79.8% (78.5%–81.0%) to 58.6% (57.2%–60.1%), and 90.8% (85.6%–96.0%) to 79.8% (76.4%–83.2%) in nonfrail, moderately frail, and severely frail patients, respectively. HF hospitalization risk remained almost constant over the study period. Non‐HF hospitalization risk declined from 74.0% (73.5%–74.5%) to 65.8% (65.0%–66.5%) in nonfrail patients and remained stable overall in moderately frail and severely frail patients over the study period. Conclusions We observed an increase in frail patients. Mortality decreased for all frailty groups but remained high for severely frail patients. These findings indicate the need for further evidence on the optimization of care for frail patients with HF, and future research should address the development of comprehensive management strategies, integrating frailty assessment into standard clinical care and focused care for older patients with HF.

AIMS The aim of this study was to test the multiple mediating effects of social support and depression symptoms on the relationship between frailty and cognitive function in older patients with heart failure. METHODS AND RESULTS We used a convenience sampling method to recruit 444 older patients with heart failure who met the inclusion criteria from a university-affiliated general hospital. Multiple mediation analyses revealed that the relationship between frailty and cognitive function was influenced by social support (effect: -0.383, 95% CI [-0.774, -0.072]) and depressive symptoms (effect: -0.349, 95% CI [-0.710, -0.134]) both individually and in tandem (effect: -0.276, 95% CI [-0.591, - 0.106]). CONCLUSION Social support and depressive symptoms are multiple mediators of the relationship between frailty and cognitive function. Healthcare providers should implement interventions that focus on maximizing social return and minimizing depressive symptoms to mitigate the decline in cognitive function.

BACKGROUND Frailty is prevalent in patients with heart failure and is associated with adverse outcomes. However, the extent to which the Clinical Frailty Scale (CFS) accurately captures physical and cognitive decline and its prognostic utility in contemporary heart failure care remain uncertain. OBJECTIVES In this study, the authors sought to examine how well the CFS reflects domains of physical and cognitive function and its association with 2-year all-cause mortality in hospitalized patients with heart failure, using data from the Japanese Registry of Acute Decompensated Heart Failure-Next (JROADHF-NEXT). METHODS This study involved 3,905 patients from a prospective, nationwide, multicenter registry focusing on hospitalized patients with heart failure (JROADHF-NEXT). Patients were stratified into 6 categories (1-2, 3, 4, 5, 6, and 7-9) according to the CFS. Physical function was assessed using gait speed, the 5-chair stand test, the Short Physical Performance Battery (SPPB), grip strength, and 6-minute walk distance; cognitive function was measured using the Mini-Cog test. The primary outcome was 2-year all-cause mortality after discharge. RESULTS Physical function metrics and Mini-Cog scores progressively worsened with increasing CFS severity. Over a 2-year follow-up, 725 patients (18.6%) died, with mortality increasing stepwise with higher CFS scores. Adding CFS to the prognostic model significantly improved discrimination compared with a model based on the SPPB and Mini-Cog test. CONCLUSIONS The CFS is an independent predictor of 2-year mortality and a robust integrative measure of physical and cognitive vulnerability in patients with heart failure. The CFS provides a practical screening tool that complements formal performance-based frailty assessments in contemporary heart failure management.

Heart failure (HF) in elderly patients is frequently associated with frailty, malnutrition and reduced functional status. This study assessed the associations between nutritional risk, functional capacity, frailty and length of hospital stay (LOHS) in elderly patients hospitalized with HF.

OBJECTIVES To investigate the relationship between social frailty (SF) and quality of life (QoL) in older heart failure individuals and to verify the mediating effect of resilience and the symptoms of depression and anxiety (DA) on this relationship. METHODS A cross-sectional study was implemented to collect data from 443 old HF patients from three tertiary hospitals based on convenient sampling. The measurement tools included a general information questionnaire, the Social Frailty Scale, the 10-item Connor-Davidson Resilience Scale, the Hospital Anxiety and Depression Scale, and the Minnesota Living with Heart Failure Questionnaire. The SPSS PROCESS Marco Plug-in was used to conduct mediation analysis. RESULTS The regression analysis showed that place of residence, the number of hospitalizations, and New York Heart Association (NYHA) classes were influencing factors of the QoL in older HF patients. The mediation analysis indicated that resilience and the symptoms of DA mediated the relationship between SF and QoL in older HF individuals, with mediating effect sizes of 45.95 % and 64.94 %, respectively. CONCLUSION SF was significantly associated with QoL in older HF patients, and resilience and the symptoms of DA mediated the relationship. Interventions paying attention to reducing SF and the symptoms of DA or enhancing resilience are beneficial for improving the QoL in older HF individuals.

Background: Frailty, with a high prevalence of 40–80% in heart failure, may have a significant bearing on outcomes in patients. This study utilizes the Hospital Frailty Risk Score (HFRS), a validated tool derived from the administrative International Classification of Diseases, 10th Revision, Clinical Modifications (ICD-10-CM) codes, in investigating the mortality, morbidity, and healthcare resource utilization among heart failure hospitalizations using the Nationwide Inpatient Sample (NIS). Methods: A retrospective analysis of the 2021 NIS database was assessed to identify adult patients hospitalized with heart failure. These patients were stratified by the HFRS into three groups: low frailty (LF: <5), intermediate frailty (IF: 5–15), and high frailty (HF: >15). The outcomes analyzed included inpatient mortality, length of stay (LOS), hospitalization charges, and complications including cardiogenic shock, cardiac arrest, acute kidney injury, and acute respiratory failure. These outcomes were adjusted for age, race, gender, the Charlson comorbidity score, hospital location, region, and teaching status. Multivariate logistic and linear regression analyses were used to assess the association between frailty and clinical outcomes. STATA/MP 18.0 was used for statistical analysis. Results: Among 1,198,988 heart failure admissions, 47.5% patients were in the LF group, whereas the IF and HF groups had 51.1% and 1.4% patients, respectively. Compared to the LF group, the IF group showed a 4-fold higher (adjusted OR = 4.60, p < 0.01), and the HF group had an 11-fold higher (adjusted OR 10.90, p < 0.01) mortality. Frail patients were more likely to have a longer length of stay (4.24 days, 7.18 days, and 12.1 days in the LF, IF, and HF groups) and higher hospitalization charges (USD 49,081, USD 84,472, and USD 129,516 in the LF, IF, and HF groups). Complications were also noticed to be significantly (p < 0.01) higher with increasing frailty from the LF to HF groups. These included cardiogenic shock (1.65% vs. 4.78% vs. 6.82%), cardiac arrest (0.37% vs. 1.61% vs. 3.16%), acute kidney injury (19.2% vs. 54.9% vs. 74.6%), and acute respiratory failure (29.6% vs. 51.2% vs. 60.3%). Conclusions: This study demonstrates the application of HFRS in a national dataset as a predictor of outcome and resource utilization measures in heart failure admissions. Stratifying patients based on HFRS can help in holistic assessment, aid prognostication, and guide targeted interventions in heart failure.

BACKGROUND People with frailty have increased prevalence and incidence of atrial fibrillation (AF). OBJECTIVE The study aimed to further investigate the association of long-term changes in frailty with risk of new-onset AF. Its associations with heart failure (HF), coronary heart disease (CHD), and stroke were also evaluated as a secondary aim. METHODS Over 50,000 participants from UK Biobank cohort were included, with frailty index (FI) data and free of AF, HF, CHD or stroke in baseline and follow-up assessments. Frailty status of the participants was categorized into non-frail, pre-frail and frail based on their FI scores. FI in baseline and follow-ups are used to calculate the trajectories of frailty (ΔFI). RESULTS During a median of 5.1 years of follow-up from the final assessment, 1729 cases of AF were recorded. Frailty trajectory analysis showed that even a 0.01 point/year increase in ΔFI was associated with 14% (95% CI 1.08-1.20) higher risk of AF, independent of baseline FI after adjusting for potential confounders. Compared with maintained non-frail participants, those with sustained frail status had the highest risk of incident AF (HR 1.95, 1.61-2.36). The risk declined by 30% (95% CI 0.53-0.94) when frail participants regressed to non-frail or pre-frail status, compared with sustained frail participants. These associations were similar in HF and CHD, however, not significant in stroke. CONCLUSION In middle-aged and elderly individuals, frailty remission or non-frailty maintenance was associated with lower risk of AF, HF and CHD compared to persistent frailty, regardless of prior frailty status and established risk factors.

Approximately 50% of all adults with heart failure (HF) are classified as frail. Frailty is a clinical state of 'accelerated ageing' that complicates management and results in adverse health outcomes. Despite recommendations for frailty assessment in HF guidelines, its implementation into routine clinical practice has been slow. Further, evidence to inform models of care and pharmacological treatment for individuals with HF who are classified as frail is lacking. The complexity of management underscores the importance of tailoring models of care that can improve the focus on frailty through multidisciplinary care teams. Frailty can be reduced in some cases through the comprehensive geriatric assessment model of care, integrating treatment pillars such as exercise, nutrition, social engagement and support networks, and optimised medication use. A national agenda for action on frailty in the context of HF is needed to advance policy, practice, education, and research improve health outcomes for individuals affected. In November 2023 the Australian Cardiovascular Alliance (ACvA) facilitated a national workshop on frailty and HF with key experts. This has led to the development of a frailty and HF national taskforce with the aim to address major priorities and unmet needs. This statement is first step for the taskforce in implementing a national agenda for the management of frailty in HF. Here we outline key considerations for policy, practice, education, and research in Australia.

The aim of this study was to compare the differences in length of stay (LoS) and prior hospitalization due to heart failure (HHF) in patients with HF and frailty versus without frailty.

ABSTRACT Aims To explore the conceptualisation of social frailty and discuss its role in shaping the disease trajectory of heart failure. Based on the discussion, recommendations on how to prevent and manage social frailty in this clinical cohort are delineated. Design A discursive paper. Methods This paper searched two databases, PubMed and Google Scholar, for a narrative review of the literature related to social frailty and heart failure from 2008 to 2024. Findings By integrating the conceptualisation of social frailty from different theoretical paradigms, social frailty is a multi‐domain construct that relies on a balance between the availability of environmental resources, social interactions and an individual's ability to maintain and acquire these resources to enhance their well‐being. Substantial evidence showed the prognostic impact of social frailty on patient‐reported, functional and clinical outcomes of patients with heart failure. The underlying mechanism is still under‐investigated, but heart failure‐related self‐care may mediate its impact. Based on this evidence, improving social frailty may rely on a diagnostic protocol to enhance the person‐centred care planning on ways to optimise the social resources to support complex self‐care. Conclusion Social frailty poses a greater risk to health outcomes in patients with heart failure. Further research is needed to explore determinants and interventions for social frailty in this population. Implications This paper increases the awareness of social frailty in heart failure patients and provides important insights on how to combat this social determinant of poor health outcomes among this clinical cohort. A dual‐purpose approach of improving social resources and self‐care behaviours may have great promise in reducing their social frailty, and this postulation will need to be investigated in future research. Patient or Public Contribution There is no involvement of patients or the public in the design or writing of this discursive paper.

Frailty, a multidimensional condition, poses significant challenges in heart failure (HF) patients, frequently leading to increased nursing complexity and prolonged hospital length of stay (LOS). This study aims to investigate the association between frailty and nursing complexity, as well as their combined influence on hospital length of stay (LOS) in HF patients. A retrospective observational study was conducted at an Italian university hospital, including all patients with HF admitted consecutively over one year. Frailty was measured using the Blaylock Risk Assessment Screening Score (BRASS), classifying patients into low (score ‹10), moderate (score 10–19), and high (score ≥20) risk categories. Nursing complexity was measured using the Nursing Dependency Index (NDI), defined as the number of nursing diagnoses per patient on hospital admission. Prolonged LOS was defined as stays exceeding the 75th percentile. Data were collected using the hospital discharge register and the Professional Assessment Instrument, a system designed to record nursing care. Pearson correlation analyses were conducted to explore relationships between variables. Latent Class Analysis (LCA) identified nursing complexity and frailty profiles, while logistic regression evaluated associations between LCA profiles and prolonged LOS. Among 608 patients (mean age 75.7 ± 13.06), the mean NDI score was 4.31 ± 3.44, and the mean BRASS score was 8.01 ± 6.00. The NDI increased significantly with frailty risk (low: 3.96 ± 3.34; moderate: 5.46 ± 3.71; high: 5.31 ± 3.00; F = 10.212, p ‹ 0.001). Correlations were observed between NDI and frailty (r = 0.213, p ‹ 0.001), NDI and LOS (r = 0.127, p ‹ 0.005), and frailty and LOS (r = 0.179, p ‹ 0.001). LCA identified two profiles: low complexity/low frailty (NDI: 3.62 ± 3.06, BRASS: 6.39 ± 4.50) and high complexity/high frailty (NDI: 6.92 ± 3.58, BRASS: 14.1 ± 6.96). Model fit indices indicated an acceptable fit (log–likelihood = –3193, AIC = 6585, BIC = 7021, and entropy = 0.726), demonstrating good class separation. Logistic regression showed that the high complexity/high frailty profile increased the odds of prolonged LOS by 87% (OR = 1.867, 95% CI: 1.225–2.846, p ‹ 0.005). Higher nursing complexity and frailty are strongly associated with prolonged LOS in HF patients. Identifying distinct profiles of complexity and frailty can guide tailored interventions to improve outcomes and optimize resource use.

PURPOSE Previous research has explored the factors influencing frailty in older patients with chronic heart failure (CHF), but these studies have not revealed the potential network interactions among the related factors. This study aimed to construct a Bayesian network (BN) model of frailty in older patients with CHF, analyze the predictive factors and explore the internal relationships between these factors. METHODS A total of 439 older patients with CHF were selected using a convenience sampling method from September 2023 to March 2024 at the cardiology department of a comprehensive tertiary hospital in Nanchang, Jiangxi, China. Multivariate logistic regression analysis was used to explore the influencing factors of frailty in older patients with CHF. The BN structure was learned using the max-min hill-climbing algorithm, with parameter estimation achieved through maximum likelihood estimation. Netica software was utilized for prediction and diagnosis. The effectiveness of the model was validated using the ROC curve. RESULTS The prevalence of frailty in older patients with CHF was found to be 53.3%. After using a multivariate logistic regression analysis model screened the variables, the nutritional risk, physical activity, depression, multimorbidity, grip strength and left atrial diameter were included into the Bayesian network model. The Bayesian network model of frailty related factors in older CHF patients showed that nutritional risk, physical activity, depression, and multimorbidity were directly related to frailty, while grip strength and left atrial diameter were indirectly related. CONCLUSION The study results indicated that malnutrition risk, inactivity, depression, and multimorbidity were directly related to frailty, while lower grip strength and a wider left atrial diameter were indirectly related to frailty. Enhancing frailty assessment and implementing measures addressing disease, nutrition, exercise, and psychological well-being are crucial for delaying and potentially reversing the onset and progression of frailty.

Background and objectives Older patients with chronic heart failure have severe somatic symptoms, which lead to high levels of social frailty and loss of quality of life. Understanding the demographic and disease factors of quality of life and its relationship with social frailty is beneficial to overall health for older patients with chronic heart failure. This study aims to explore the relationship between social frailty and quality of life in older patients with chronic heart failure and to verify whether family insufficiency and social networks moderate this relationship. Methods A multi-centre cross-sectional study was conducted on 443 older patients with chronic heart failure from three tertiary hospitals in China. The study questionnaire included a general information questionnaire, the HALFT scale (social frailty), the Family APGAR Index (family insufficiency), the LSNS-6 (social networks), and the MLHFQ (quality of life). Hierarchical regression analysis was used to assess the factors influencing quality of life; the SPSS PROCESS Marco Plug-in was employed to conduct mediation analysis. Results The results showed that age, the number of hospitalizations, and NYHA classification influenced the quality of life in older patients with chronic heart failure. Social frailty, family insufficiency, and social networks were related, and family insufficiency and social networks mediated the relationship between social frailty and quality of life, with mediating effect sizes of 25.87, 99.5 and 58.97%, respectively. Conclusion This study shows that high levels of social frailty are associated with reduced quality of life in older patients with chronic heart failure. Decreasing family insufficiency and extending social networks help alleviate social frailty’s adverse effects on the quality of life in older patients with chronic heart failure.

Nutritional status is a critical determinant of clinical outcomes in patients with chronic heart failure (CHF), potentially contributing to adverse prognosis and suboptimal therapeutic response. Despite growing interest, the interplay between malnutrition and frailty syndrome (FS) in the CHF population remains inadequately elucidated.

Frailty often coexists with heart failure (HF), which significantly aggravates the clinical outcomes of older adults. However, studies investigating the interplay between frailty and HF in older adults are scarce. We aimed to assess the prevalence of frailty using the cumulative deficit approach and evaluate the impacts of frailty on health utilization, use of HF‐related medications and adverse clinical outcomes (all‐cause mortality, all‐cause readmissions and HF readmissions) among older HF patients.

Frailty is highly prevalent in patients with heart failure (HF), but a concordant definition of this condition is lacking. The Heart Failure Association of the European Society of Cardiology (HFA‐ESC) proposed in 2019 a new multi‐domain definition of frailty, but it has never been validated.

Importance Heart failure (HF) and frailty frequently coexist and may share a common pathobiology, although the underlying mechanisms remain unclear. Understanding these mechanisms may provide guidance for preventing and treating both conditions. Objective To identify shared pathways between incident HF and frailty in late life using large-scale proteomics. Design, Setting, and Participants In this cohort study, 4877 aptamers (Somascan v4) were measured among participants in the community-based longitudinal Atherosclerosis Risk In Communities (ARIC) cohort study at visit 3 (V3; 1993-1995; n = 10 638) and at visit 5 (V5; 2011-2013; n = 3908). Analyses were externally replicated among 3189 participants in the Cardiovascular Health Study (CHS). Data analysis was conducted from February 2022 to June 2023. Exposures Protein aptamers, measured at study V3 and V5. Main Outcomes and Measures Outcomes assessed included incident HF hospitalization after V3 and after V5, prevalent frailty at V5, and incident frailty between V5 and visit 6 (V6; 2016-2017; n = 4131). Frailty was assessed using the Fried criteria. Analyses were adjusted for age, gender, race, field center, hypertension, diabetes, smoking status, body mass index, estimated glomerular filtration rate, prevalent coronary heart disease, prevalent atrial fibrillation, and history of myocardial infarction. Mendelian randomization (MR) analysis was performed to assess potential causal effects of candidate proteins on HF and frailty. Results A total of 4877 protein aptamers were measured among 10 638 participants at V3 (mean [SD] age, 60 [6] years; 4886 [46%] men). Overall, 286 proteins were associated with incident HF after V3 (822 events; P < 1.0 × 10-5), 83 of which were also associated with incident after V5 (336 events; P < 1.7 × 10-4). Among HF-free participants at V5 (n = 3908; mean [SD] age, 75 [5] years; 1861 [42%] men), 48 of 83 HF-associated proteins were associated with prevalent frailty (223 cases; P < 6.0 × 10-4), 18 of which were also associated with incident frailty at V6 (152 cases; P < 1.0 × 10-3). These proteins enriched fibrosis and inflammation pathways and demonstrated stronger associations with incident HF with preserved ejection fraction (HFpEF) than HF with reduced ejection fraction. All 18 proteins were associated with both prevalent frailty and incident HF in CHS. MR identified potential causal effects of several proteins on frailty and HF. Conclusions and Relevance In this study, the proteins associated with risk of HF and frailty enrich for pathways related to inflammation and fibrosis as well as risk of HFpEF. Several of these proteins could potentially contribute to the shared pathophysiology of frailty and HF.

Frailty is highly prevalent among patients with heart failure (HF) and independently predicts adverse outcomes. However, optimal frailty definitions, assessments, and management in HF remain unclear. Frailty is common in HF, affecting up to 80% of patients depending on population characteristics. Even pre-frailty doubles mortality risk versus robust patients. Frailty worsens HF prognosis through systemic inflammation, neurohormonal changes, sarcopenia, and micronutrient deficiency. Simple screening tools like gait speed and grip strength predict outcomes but lack HF-specificity. Comprehensive geriatric assessment is ideal but not always feasible. Exercise, nutrition, poly-pharmacy management, and multidisciplinary care models can help stablize frailty components and improve patient-centred outcomes. Frailty frequently coexists with and exacerbates HF. Routine frailty screening should guide supportive interventions to optimize physical, cognitive, and psychosocial health. Further research on HF-specific frailty assessment tools and interventions is warranted to reduce this dual burden.

AIM To analyse factors associated with cognitive frailty among older chronic heart failure patients in China. DESIGN A cross-sectional design. METHODS Between August 2021 and November 2022, a total of 421 chronic heart failure patients (age ≥60 years) were randomly selected from the cardiology department of the affiliated hospital of Zunyi Medical University. The FRAIL scale, Mini-Mental State Examination, 15-item Geriatric Depression Scale, Social Support Rating Scale, Short-form Mini Nutritional Assessment and Pittsburgh Sleep Quality Index were utilized for measurement and evaluation. The demographic and clinical characteristics of patients were collected. To select initial variables, the Least Absolute Shrinkage Selection Operator was applied, and then logistic regression analysis was used to confirm associating factors. RESULTS Among 421 elderly people with chronic heart failure, 83 cases (19.7%) showed cognitive frailty. Of 31 variables, seven were selected by Least Absolute Shrinkage Selection Operator regression. Finally, multivariate logistic regression revealed that the age, monthly salary, drinking, NYHA classification, length of hospital stay, depression and malnutrition risk/malnutrition were independently associated with cognitive frailty. CONCLUSION The high proportion of cognitive frailty in older people with chronic heart failure should be concerned. Additionally, in the setting of cognitive frailty, efforts to diagnose it and develop interventions to prevent or reverse cognitive frailty status among older chronic heart failure patients are necessary. IMPACT The findings of our study highlight the necessity to evaluate cognitive frailty in older people with chronic heart failure and provide a new perspective and scientific basis for medical staff to develop individualized and specific interventions to prevent or reverse cognitive frailty status. REPORTING METHOD This study has been reported in compliance with STROBE reporting guidelines for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.

BACKGROUND Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the association of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF METHODS: Our data come from the FRAGIC study ("impacto de la FRAGilidad y otros síndromes Geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio con Insuficiencia Cardíaca"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Renal function was assessed according to CKD-EPI formula. A comprehensive geriatric assessment was performed and frailty was identified according to visual mobility scale (frail if VMS≥2). Survival rates were analyzed by Cox regression model. RESULTS We included 499 patients, mean age 81.4 ± 4.3 years, 38 % women. Mean estimated glomerular filtration rate (eGFR) was 52.1 ± 17.5 ml/min/1.72 m2. Patients were classified in normal renal function (eGFR≥60 ml/min/1.72m2, 182 patients, 36 %), moderately impaired (eGFR 30-59 ml/min/1.72m2, 261 patients, 52.7 %) and severely impaired (eGFR<30 ml/min/1.72m2, 56 patients, 11.3 %). Patients with severe CKD were older, more often female, and presented a worse clinical profile, with higher comorbidity burden and frailty. After a median follow up of 371 days, 58 patients (11.6 %) died. Mortality was higher in patients with worse renal function (8.8 %, 11 % and 21 % according to renal function subgroups, respectively, p = 0.036) and frailty in the univariate analysis. However, only frailty, according to VMS, but not severe renal dysfunction, was independently associated with one year mortality. CONCLUSIONS Most HF patients≥75 years have renal dysfunction. CKD is a marker of worse prognosis in elderly patients with chronic HF, but it does not independently associate one-year mortality in the presence of frailty.

Cognitive frailty (CF) is currently a significant issue, and most of the associated factors discovered in current studies are not modifiable. Therefore, it is crucial to identify modifiable risk factors that can be targeted for interventions in patients with chronic heart failure (CHF). This study aimed to investigate the prevalence and modifiable risk factors of CF in CHF patients in China. In this cross-sectional study, we sequentially enrolled patients diagnosed with CHF. CF served as the dependent variable, assessed through the Montreal Cognitive Assessment (MoCA) Scale and the FRAIL Scale. The independent variable questionnaire encompassed various components, including general demographic information, the Social Support Rating Scale (SSRS), the Simplified Nutrition Appetite Questionnaire (SNAQ), the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Logistic regression analysis was employed to identify independent factors contributing to CF. A total of 271 patients with CHF were included in the study. The overall prevalence of CF was found to be 49.4%, with 28.8% of patients exhibiting potentially reversible cognitive frailty and 20.7% showing reversible cognitive frailty. Among middle-young CHF patients, 10.7% had reversible cognitive frailty and 6.4% had potentially reversible cognitive frailty, with a prevalence of CF at 17.1%. Logistic regression analysis revealed that body mass index (OR = 0.826, 95%CI = 0.726–0.938), blood pressure level (OR = 2.323, 95%CI = 1.105–4.882), nutrition status (OR = 0.820, 95%CI = 0.671–0.979), and social support (OR = 0.745, 95%CI = 0.659–0.842) were independent factors associated with CF (p < 0.05). We observed a relatively high prevalence of CF among Chinese patients diagnosed with CHF. Many factors including BMI, blood pressure level, nutrition status, and social support emerging as modifiable risk factors associated with CF. We propose conducting clinical trials to assess the impact of modifying these risk factors. The outcomes of this study offer valuable insights for healthcare professionals, guiding them in implementing effective measures to improve the CF status in CHF patients during clinical practice.

The frailty index based on laboratory tests (FI‐lab) can identify individuals at increased risk for adverse health outcomes. The association between the FI‐lab and all‐cause mortality in patients with heart failure (HF) in the intensive care unit (ICU) remains unknown. This study aimed to determine the correlation between FI‐lab and all‐cause mortality to evaluate the impact of FI‐lab on the prognosis of critically ill patients with HF.

Chronic heart failure (CHF) is a significant global health challenge, and frailty is common among CHF patients. Although abundant evidence has revealed significant intercorrelations among health literacy, social support, self-management, and frailty, no study has explored their associations into 1 model based on a theoretical framework. The study aimed to test the Information-Motivation-Behavioral Skills Model in a sample of Chinese CHF patients and explore the potential relationships among social support, health literacy, self-management, and frailty. A cross-sectional study was conducted on CHF patients (n = 219) at a tertiary hospital in China. The Tilburg Frailty Indicator, Heart Failure Specific Health Literacy Scale, Social Support Rating Scale, and Self-management Scale of Heart Failure Patients were used to assess frailty, health literacy, social support, and self-management, respectively. Structural equation modeling with the bootstrapping method was used to test the hypothesized relationships among the variables. The results showed that 47.9% of the CHF patients suffered from frailty. Frailty was negatively correlated with health literacy (r = −0.268, P < .01) with a moderate effect size, social support (r = −0.537, P < .01) with a large effect size, and self-management (r = −0.416, P < .01) with a moderate effect size. The structural equation modeling model showed that social support was positively associated with health literacy (β = 0.419, P < .01) and self-management (β = 0.167, P < .01) while negatively associated with frailty (β = −0.494, P < .01). Health literacy was positively associated with self-management (β = 0.565, P < .01), and self-management was negatively associated with frailty (β = −0.272, P < .01). Our study suggests the potential positive impacts of health literacy, social support, and self-management on improving frailty in CHF patients. Healthcare providers should strengthen patient health education, improve their health literacy, enhance their social support, and promote their self-management so as to reverse frailty and reduce the risk of adverse outcomes.

BACKGROUND: Although frailty is strongly associated with mortality in patients with heart failure (HF), the risk of which specific cause of death is associated with being complicated with frailty is unclear. We aimed to clarify the association between multidomain frailty and the causes of death in elderly patients hospitalized with HF. METHODS: We analyzed data from the FRAGILE-HF cohort, where patients aged 65 years and older, hospitalized with HF, were prospectively registered between 2016 and 2018 in 15 Japanese hospitals before discharge and followed up for 2 years. All patients were assessed for physical, social, and cognitive dysfunction, and categorized into 3 groups based on their number of frailty domains (FDs, 0–1, 2, and 3). Kaplan-Meier survival analysis was used to evaluate the association between the number of FDs and all-cause mortality, whereas Fine-Gray competing risk regression analysis was used for assessing the impact on cause-specific mortality. RESULTS: We analyzed 1181 patients with HF (81 years old in median, 57.4% were male), 530 (44.9%), 437 (37.0%), and 214 (18.1%) of whom were categorized into the FD 0 to 1, FD 2, and FD 3 groups, respectively. During the 2-year follow-up, 240 deaths were observed (99 HF deaths, 34 cardiovascular deaths, and 107 noncardiovascular deaths), and an increase in the number of FD was significantly associated with mortality (Log-rank: P<0.001). The Fine-Gray competing risk analysis adjusted for age and sex showed that FDs 2 (subdistribution hazard ratio, 1.77 [95% CI, 1.11–2.81]) and 3 (2.78, [95% CI, 1.69–4.59]) groups were associated with higher incidence of noncardiovascular death but not with HF and other cardiovascular deaths. CONCLUSIONS: Although multidomain frailty is strongly associated with mortality in older patients with HF, it is mostly attributable to noncardiovascular death and not cardiovascular death, including HF death. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: UMIN000023929

Guideline directed medical therapy for heart failure for older people with frailty may do more harm than good, say Henry Woodford and colleagues

Background There is growing interest in the intersection of frailty and heart failure (HF); however, large-sample longitudinal studies in the general population are lacking. Objectives The goal of this study was to examine the longitudinal relationship between frailty and incident HF, and whether age and genetic predisposition could modify this association. Methods This prospective cohort study included 340,541 participants (45.7% male; mean age 55.9 ± 8.1 years) free of HF at baseline in the UK Biobank. Frailty was assessed by using the Fried frailty phenotype and included weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength. The weighted polygenetic risk score was calculated. Cox models were used to estimate these associations and the interaction between the 2 factors. Results During a median 14.1 years of follow-up, 7,590 patients with HF were documented. Compared with nonfrail participants, both prefrail and frail participants had a positive association with the risk of incident HF (prefrail HR: 1.40 [95% CI: 1.17-1.67]; frail HR: 2.07 [95% CI: 1.67-2.57]). Exhaustion (HR: 1.21; 95% CI: 1.03-1.43), slow gait speed (HR: 1.62; 95% CI: 1.39-1.90), and low grip strength (HR: 1.31; 95% CI: 1.14-1.51) were associated with a greater risk of incident HF. Furthermore, genetic susceptibility did not significantly modify the associations (Pinteraction = 0.094), and the association was significantly strengthened in younger participants (Pinteraction = 0.008). Conclusions Frailty status was associated with a higher risk of incident HF independent of genetic risk. A younger population may be more susceptible to HF when exposed to frailty. Whether the modification of frailty status represents another avenue for preventing HF warrants further investigation.

Prevention and diagnosis of frailty syndrome (FS) in patients with heart failure (HF) require innovative systems to help medical personnel tailor and optimize their treatment and care. Traditional methods of diagnosing FS in patients could be more satisfactory. Healthcare personnel in clinical settings use a combination of tests and self-reporting to diagnose patients and those at risk of frailty, which is time-consuming and costly. Modern medicine uses artificial intelligence (AI) to study the physical and psychosocial domains of frailty in cardiac patients with HF. This paper aims to present the potential of using the AI approach, emphasizing machine learning (ML) in predicting frailty in patients with HF. Our team reviewed the literature on ML applications for FS and reviewed frailty measurements applied to modern clinical practice. Our approach analysis resulted in recommendations of ML algorithms for predicting frailty in patients. We also present the exemplary application of ML for FS in patients with HF based on the Tilburg Frailty Indicator (TFI) questionnaire, taking into account psychosocial variables.

Background Frailty is common in heart failure (HF) and is associated with death but not routinely captured clinically. Frailty is linked with inflammation and malnutrition, which can be assessed by a novel plasma multimarker score: the metabolic vulnerability index (MVX). We sought to evaluate the associations between frailty and MVX and their prognostic impact. Methods and Results In an HF community cohort (2003–2012), we measured frailty as a proportion of deficits present out of 32 physical limitations and comorbidities, MVX by nuclear magnetic resonance spectroscopy, and collected extensive longitudinal clinical data. Patients were categorized by frailty score (≤0.14, >0.14 and ≤0.27, >0.27) and MVX score (≤50, >50 and ≤60, >60 and ≤70, >70). Cox models estimated associations of frailty and MVX with death, adjusted for Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) score and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide). Uno's C‐statistic measured the incremental value of MVX beyond frailty and clinical factors. Weibull's accelerated failure time regression assessed whether MVX mediated the association between frailty and death. We studied 985 patients (median age, 77; 48% women). Frailty and MVX were weakly correlated (Spearman's ρ=0.21). The highest frailty group experienced an increased rate of death, independent of MVX, MAGGIC score, and NT‐proBNP (hazard ratio, 3.3 [95% CI, 2.5–4.2]). Frailty improved Uno's c‐statistic beyond MAGGIC score and NT‐proBNP (0.69–0.73). MVX only mediated 3.3% and 4.5% of the association between high and medium frailty groups and death, respectively. Conclusions In this HF cohort, frailty and MVX are weakly correlated. Both independently contribute to stratifying the risk of death, suggesting that they capture distinct domains of vulnerability in HF.

Background Physical frailty and malnutrition coexist in older patients with heart failure (HF) and form a vicious cycle exacerbating each other and can cause poor clinical outcomes. We aimed to clarify the association of prevalence of physical frailty and malnutrition and clinical outcomes in hospitalized patients with HF. Methods A total of 862 hospitalized patients aged ≥65 years with HF decompensation were included in this FRAGILE-HF post-hoc sub-analysis. Patients were categorized into Neither, Either, or Both groups based on the prevalence of physical frailty and malnutrition. The primary outcome was all-cause mortality within 1 year after discharge. Prognoses among the groups were compared in the entire cohort and in subgroups with preserved ejection fraction (pEF) and reduced/mildly reduced left ventricular ejection fractions (rEF/mrEF). Results The Neither, Either, and Both groups comprised 32 %, 40 %, and 28 % respectively. During a 1-year follow-up period, 101 (12 %) patients died. Kaplan–Meier analysis showed significant differences in the primary outcomes among the groups (P < 0.001). The Both group had a higher risk of mortality (HR: 2.47, 95 % CI: 1.38–4.42) than the Neither group, while the Either group showed insignificant risk increase (HR: 1.58, 95 % CI: 0.86–2.90). Similar trends were observed in the pEF and rEF/mrEF subgroups (P = 0.60). Conclusions Physical frailty and malnutrition coexist in approximately one-quarter of hospitalized older patients with HF and are associated with an increased risk of mortality. Assessing both conditions is crucial for risk stratification and interventions to mitigate their interplay.

Low physical function in patients with heart failure (HF) has been associated with an increased risk of poor prognosis. Cardiac rehabilitation (CR) improves physical function and reduces the incidence of adverse events, including death and HF rehospitalisation. However, it remains unclear which aspects of physical function improvements, such as walking speed or balance ability, through CR relate to prognosis. To examine changes in each component of the Short Physical Performance Battery (SPPB) during CR and investigate the relationship between these changes and prognosis. We retrospectively reviewed 665 patients with HF aged 60 years and older (median age: 78 years) who participated in CR. Patients were assessed SPPB twice at admission and discharge. A mixed-effects model was used to examine changes in the components of the SPPB after CR participation. Cox regression analysis and log-rank tests were also performed to assess the association between each SPPB component change and prognosis. The log-rank test was conducted using tertiles of the degree of change in each SPPB component, dividing patients into high, medium, and low improvement groups. A total of 167 deaths occurred over a median follow-up period of 1.69 years (interquartile range: 0.70–3.39). The mixed-effects model results indicated a slight decrease in scores for balance but a significant improvement in scores for 4-m walking speed and five sit-to-stand tests (5-STS). (Balance: main effect of time, −0.15 points; p < 0.001; 5-STS: main effect of time, +1.98 points; p < 0.001; 4-m walking speed: main effect of time, +1.26 points; p < 0.001). Cox regression analysis showed that an improving score in the 4-m walk speed component was independently associated with a reduced risk of all-cause mortality, while improvement in balance and 5-STS were not significantly associated with the risk of all-cause mortality. [balance; adjusted hazard ratio (aHR): 0.91; 95 % confidence interval (CI): 0.80-1.03; p = 0.135, 5-STS; aHR: 0.86; 95 % CI: 0.73-1.00; p = 0.054, 4-m walk speed; aHR: 0.77; 95 % CI: 0.66-0.91; p = 0.002]. In older HF patients participating in CR, improvements were mainly observed in 4-m walking speed and the 5-STS. Among the SPPB components, an increase in the 4-m walking speed score was associated with a better prognosis. These findings suggest that intervention and assessment of walking ability in CR may be critical during hospitalisation.

No abstract available

Supplemental Digital Content is available in the text. Background: Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction. Methods: This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants. Results: Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65–0.92) for composite outcome, 0.67 (95% CI, 0.51–0.87) for all-cause mortality, and 0.82 (95% CI, 0.67–0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients. Conclusions: Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.

Background Whether frailty, defined as a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors, may impact the outcomes of elderly patients admitted to a cardiac intensive care unit (CICU) remains unclear. We aimed to determine the prevalence of frailty and its impact on mortality in patients aged ≥ 80 years admitted to a CICU. Methods This prospective single-centre observational study was conducted among patients aged ≥ 80 years admitted to a CICU in a tertiary centre. Frailty was assessed using the Edmonton Frail Scale (EFS), which provides a score ranging from 0 (not frail) to 17 (very frail). The population was divided into 3 classes: EFS-score of 0-3, EFS-score of 4-6, and EFS-score > 7. Results A total of 199 patients were included, and median follow-up duration was 365 days. The mean age was 84.8 years, and 50 patients (25.1%) died during the follow-up period. In all, 45 (22.6%), 60 (30.2%), and 94 patients (47.2%) had an EFS-score of 0-3, 4-6, and ≥ 7, respectively. The all-cause mortality rate was 4.4%, 27.1%, and 37.2% in the 0-3, 4-6, and ≥ 7 EFS-score groups, respectively (P < 0.001). After multivariate analysis, frailty status remained associated with all-cause mortality: hazard ratio was 2.60 (95% confidence interval 0.54-12.45) within the 4-6 EFS-score group, and 5.46 (95% confidence interval 1.23-24.08) within the ≥ 7 EFS-score group. Conclusions Frailty is highly prevalent in older adults admitted to the population hospitalized in a CICU and represents a strong prognostic factor for 1-year all-cause mortality.

Background Cardiac amyloidosis is associated with poor prognosis. Biopsy-induced severe mitral regurgitation (MR) secondary to chordal rupture is a rare but critical complication, and its optimal management remains uncertain. Case Summary A 78-year-old man with transthyretin cardiac amyloidosis developed acute severe MR after left ventricular myocardial biopsy, which caused rupture of the chordae tendineae. He presented with NYHA functional class IV heart failure. Given his condition, transcatheter edge-to-edge mitral valve repair (M-TEER) was prioritized. A MitraClip was successfully deployed, reducing the severe MR to mild without complications, and his symptoms markedly improved. Discussion This is to our knowledge the first reported case of biopsy-induced MR in cardiac amyloidosis successfully managed using M-TEER. This case demonstrates the safety and efficacy of M-TEER in frail patients with iatrogenic mechanical complications. Take-Home Message M-TEER may be a life-saving therapy for severe iatrogenic MR in patients with advanced cardiac amyloidosis.

An increased interest regarding the impact of frailty on the prognosis of cardiovascular disease (CVD) has been observed in the last decade. Frailty is a syndrome characterized by a reduced biological reserve that increases the vulnerability of an individual in relation to stressors. Among the patients with CVD, a higher incidence of frailty has been reported in those with heart failure (HF). Regardless of its conceptualizations, frailty is generally associated with negative outcomes in HF and an increased risk of mortality. Psychological factors, such as depression and anxiety, increase the risk of negative outcomes on the cardiac function and mortality. Depression and anxiety are found to be common factors impacting the heart disease and quality of life (QoL) in patients with HF. Depression is considered an independent risk factor of cardiac-related incidents and death, and a strong predictor of rehospitalization. Anxiety seems to be an adequate predictor only in conjunction with depression. The relationship between psychological factors (depression and anxiety) and frailty in HF has hardly been documented. The aim of this paper is to review the reported data from relevant studies regarding the impact of depression and anxiety, and their effects on clinical outcomes and prognosis in frail patients with HF.

No abstract available

Cardiovascular disease (CVD) is a common problem in the elderly. In particular, the morbidity and mortality of patients with heart failure (HF) increase with age. The poor outcomes of elderly patients with HF can be explained partly by cardiac aging at the cellular and organ levels. Moreover, recent evidence has demonstrated that functional evaluation, which may reflect the status of individual aging, predicts mortality in patients with HF. Age-related changes occur throughout the body and in virtually all organ systems. Thus, we should pay more attention to geriatric conditions when treating patients with HF. Frailty represents a complex clinical syndrome that results from multiple impairments across different organs and is characterized by decreased physiological reserves and increased vulnerability to stressors. Frail patients with CVD have a worse prognosis than non-frail patients. Evidence demonstrates that frailty is an independent risk factor for incident HF among older people. The ways in which cellular senescence promotes age-related CVD and frailty remain an important issue in the biology of aging and clinical geriatrics. Senescent cells that have acquired a senescence-associated secretory phenotype (SASP) can cause local and potentially systemic inflammation. SASP might be a key phenomenon in the association between cellular senescence and the development of age-related CVD and frailty. Frailty is a dynamic and potentially reversible state; therefore, translational research efforts are focused on obtaining mechanistic insights into the pathobiology of frailty, the development of novel therapeutics, and the identification of biomarkers for frailty. This is particularly important in developed countries that are confronted with an aging society.

Prognosis of advanced heart failure (HF) patients, often elderly, frail and with multiple comorbidities, has significantly improved due to recent advancements in interventional cardiology. A multidisciplinary approach is essential in order to better identify patients that could benefit from invasive procedures, avoiding futility. For patients with HF, the Multidimensional Prognostic Index could help the clinician in predicting not only the prognosis but also future quality of life. For cardiac surgical candidates, predictive scores should combine traditional mortality scores with geriatric parameters including nutritional status, screening of delirium, disabilities and comorbidities, in order to help the Heart Team in taking the right approach (i.e. conservative vs invasive strategies). Similarly, the indication to the implantation of a cardioverter-defibrillator or to ablative procedures should consider both the complication rates and the real impact on the quality of life considering the expected net clinical benefit.In the terminal stages of HF the therapeutic target should be oriented to a palliative care approach. In this perspective, the figure of the palliativist plays a role of growing interest and should be integrated into the HF multidisciplinary team.

No abstract available

BACKGROUND The impact of frailty on long-term prognosis in patients with heart failure (HF) remains unclear, and there is no simple and objective assessment for it. This study was performed to examine the association between frailty score and clinical outcome in elderly patients hospitalized for HF. METHODS AND RESULTS A retrospective cohort study was performed with 603 elderly patients with HF (mean age 75 ± 6 years, 378 [62.7%] men). Frailty was measured by a composite of 4 markers combined into a frailty score (possible range 0-12): gait speed, handgrip strength, serum albumin, and activities of daily living status. The patient population was divided into 2 groups with frailty score <5 (non-frail) or ≥5 (frail). The end point was all-cause mortality. Over a mean follow-up period of 1.7 ± 0.5 years, 89 patients died. After adjustment for several preexisting factors associated with prognosis, the frailty score (hazard ratio [HR] 1.11; P = .014) and frailty (HR 1.75; P = .036) were independently associated with all-cause mortality. The inclusion of frailty score significantly increased both continuous net reclassification improvement (0.341; P = .002) and integrated discrimination improvement (0.016; P = .039) for all-cause mortality. CONCLUSIONS A simple and objective frailty score was associated with health outcome in elderly patients hospitalized for HF.

BACKGROUND Frailty reflects decreased resilience to physiological stressors; its prevalence and prognosis are not fully defined in heart failure with preserved ejection fraction (HFpEF). METHODS The Short Physical Performance Battery (SPPB) was prospectively obtained in 114 outpatients with HFpEF. The SPPB tests gait speed, tandem balance, and timed chair rises, each scored from 0 to 4 points. Severe and mild frailty were respectively defined as an SPPB score ≤6 and 7-9 points. We used risk-adjusted logistic, Poisson, and negative binominal regression, respectively, to assess the relationship between SPPB score and risk of death or all-cause hospitalization, number of hospitalizations, and days hospitalized or dead longer than 6 months. RESULTS Patients were similar to other HFpEF cohorts (age 68 ± 13 years, 58% female, body mass index 36 ± 8 kg/m2, multiple comorbidities). Mean SPPB score was 6.9 ± 3.2, and 80% of patients were at least mildly frail. Over a 6-month period, the SPPB score independently predicted death or all-cause hospitalization (odds ratio 0.81 per point, 95% confidence interval [CI] 0.69-0.94, P = .006), number of hospitalizations (incidence rate ratio 0.92 per point, 95% CI 0.86-0.97, P = .006), and days hospitalized or dead (incidence rate ratio 0.85 per point, 95% CI 0.73-0.99, P = .04). CONCLUSIONS Lower extremity function, as measured by the SPPB, independently predicts hospitalization burden in outpatients with HFpEF. Additional studies are warranted to explore shared mechanisms and treatment implications of frailty in HFpEF.

Tricuspid and pulmonary valve replacement in patients with advanced carcinoid heart disease (CaHD) reduces right heart failure and improves prognosis. The surgical literature is limited concerning description of technical aspects of valve replacement in CaHD. Although a dedicated multidisciplinary care is required for these frail patients, optimization of surgical technique is important and may lead to better postoperative outcomes.

No abstract available

OBJECTIVE To evaluate the impact of preoperative MDT care on perioperative management and outcomes of frail cardiac surgery patients. BACKGROUND Frail patients are at increased risk for complications and poor functional outcome after cardiac surgery. In these patients, preoperative multidisciplinary team (MDT) care may improve outcome. METHODS Between 2018 and 2021, 1168 patients ≥ 70 years were scheduled for cardiac surgery of whom 98 (8.4%) frail patients were referred for MDT care. The MDT discussed surgical risk, prehabilitation and alternative treatment. Outcomes of MDT patients were compared with 183 frail patients (non-MDT group) from a historical study cohort (2015-2017). Inverse probability of treatment weighting was used to minimize bias from non-random allocation of MDT vs. non-MDT care. Outcomes were severe postoperative complications, total days in hospital (DIH120), disability, and health-related quality of life (HRQL) after 120 days. RESULTS This study included 281 patients (98 MDT and 183 non-MDT patients). Of the MDT patients, 67 (68%) had open surgery, 21 (21%) underwent minimal invasive procedures and 10 (10%) received conservative treatment. In the non-MDT group, all patients had open surgery. Fourteen (14%) MDT patients suffered a severe complication vs 42 (23%) non-MDT patients (adjusted RR 0.76; 95% CI 0.51 - 0.99). Adjusted DIH120 was 8 (IQR 3 - 12) vs 11 (IQR 7 - 16) days for MDT and non-MDT patients, respectively (P = 0.01). There was no difference in disability or HRQL. CONCLUSIONS Preoperative MDT care for frail cardiac surgery patients is associated with alterations in surgical management and with a lower risk for severe complications.

No abstract available

Frailty is a geriatric condition characterized by the reduction of the individual's homeostatic reserves. It determines an increased vulnerability to endogenous and exogenous stressors and can lead to poor outcomes. It is an emerging concept in perioperative medicine, since an increasing number of patients undergoing surgical interventions are older and the traditional models of care seem to be inadequate to satisfy these patients' emerging clinical needs. Nowadays, the progressive technical and clinical improvements allow to offer cardiac operations to an older, sicker and frail population. For these reasons, a multidisciplinary team involving cardiac surgeons, clinical cardiologists, anesthesiologists, and geriatricians, is often needed to assess, select and provide tailored care to these high-risk frail patients to optimize clinical outcomes. There is unanimous agreement that frailty assessment may capture the individual's biological decline and the heterogeneity in risk profile for poor health-related outcomes among people of the same age. However, since commonly used preoperative scores for cardiac surgery fail to capture frailty, a specific preoperative assessment with dedicated tools is warranted to correctly recognize, measure and quantify frailty in these patients. On the contrary, pre-operative and post-operative interventions can reduce the risk of complications and support patient recovery promoting surgical resilience. Minimally invasive cardiac procedures aim to reduce surgical trauma and may be associated with better clinical outcome in this specific sub-group of high-risk patients. Among postoperative adverse events, the occurrence of delirium represents a risk factor for several unfavorable outcomes including mortality and subsequent cognitive decline. Its presence should be carefully recognized, triggering an adequate, evidence based, treatment. There is evidence, from several cross-section and longitudinal studies, that frailty and delirium may frequently overlap, with frailty serving both as a predisposing factor and as an outcome of delirium and delirium being a marker of a latent condition of frailty. In conclusion, frail patients are at increased risk to experience poor outcome after cardiac surgery. A multidisciplinary approach aimed to recognize more vulnerable individuals, optimize pre-operative conditions, reduce surgical invasivity and improve post-operative recovery is required to obtain optimal long-term outcome.

No abstract available

Graphical Abstract Graphical abstract In cardiac sarcoidosis (CS), inflammatory granulomas invade the heart leading to injury and fibrosis (yellow stars in the section of a sarcoidotic heart in the middle of the graph). CS is often subclinical, but, when clinically manifest, presents commonly with slow or fast arrhythmias or heart failure. On the left of the figure, positron emission tomography (PET) exposes focal septal uptake of 18-F fluorodeoxyglucose suggesting active inflammation (white arrow), and contrast-enhanced cardiac magnetic resonance (CMR) shows septal late gadolinium enhancement (arrows) indicating replacement fibrosis. Both constitute major diagnostic criteria for CS and entitle probable CS diagnosis if accompanied by confirmed extracardiac histology of sarcoidosis. Yet, the only way to definite diagnosis, demonstrated on the right, is myocardial biopsy showing non-necrotic granulomas (black arrow). The therapy of CS is based on immunosuppression and management of heart block, ventricular arrhythmias, and heart failure. The risk of sudden cardiac death (SCD) needs assessment and consideration of an implantable cardioverter-defibrillator (ICD). With current therapy, expected 5-year survival is well above 90% as shown by the Kaplan–Meier graph of a 398-patient Finnish CS cohort.

No abstract

The last several years have seen increasing interest in understanding cachexia, muscle wasting, and physical frailty across the broad spectrum of patients with cardiovascular illnesses. This interest originally started in the field of heart failure, but has recently been extended to other areas such as atrial fibrillation, coronary artery disease, peripheral artery disease as well as to patients after cardiac surgery or transcatheter aortic valve implantation. Tissue wasting and frailty are prevalent among many of the affected patients. The ageing process itself and concomitant cardiovascular illness decrease lean mass while fat mass is relatively preserved, making elderly patients particularly prone to develop wasting syndromes and frailty. The aim of this review is to provide an overview of the available knowledge of body wasting and physical frailty in patients with cardiovascular illness, particularly focussing on patients with heart failure in whom most of the available data have been gathered. In addition, mechanisms of wasting and possible therapeutic targets are discussed.

Clinicians are increasingly considering using frailty assessments to individualize treatment for older patients. It remains uncertain whether interventions to reduce cardiovascular disease (CVD) events offer similar benefits between older adults with and without frailty. A systematic literature search was undertaken in PubMed and Embase, adhering to PRISMA guidelines. Key inclusion criteria were randomized controlled trials published between January 2007 and September 2024 with CVD outcomes as an endpoint and data on frailty-specific treatment effects. Data were collected for population characteristics, intervention, follow-up time, frailty measure, outcome rates, and frailty subgroup treatment effect. Due to heterogeneity among the studies, the results were not pooled. The search identified 151 unique studies, of which 18 were included. Using Cochrane Risk of Bias 2.0, 12 out of the 18 studies have low risk of bias. The intervention was more effective in frail participants than in non-frail counterparts in two studies (e.g., aerobic exercise), less effective in frail participants in three studies (e.g., intensive lifestyle intervention), similarly effective across frailty levels in seven studies (e.g., prasugrel), and inconclusive in six studies (e.g., edoxaban). Some treatments were similarly effective across frailty level by hazard ratio but had a greater reduction in absolute risk for frail versus non-frail patients. Cardiovascular interventions may provide differential benefits by patients' frailty. These findings suggest the potential utility of frailty assessment for optimizing cardiovascular interventions.

No abstract

Sarcopenia is a progressive skeletal muscle disorder involving an accelerated loss of muscle mass and function. Frailty is characterized by a decline in the functioning of multiple physiological systems and an increased vulnerability to stressors. The incidence of these pathological conditions increases with age and is often accompanied by various acute or chronic disorders. The presence of sarcopenia or frailty in patients with other diseases is associated with poor outcomes. For example, frailty is highly prevalent in patients with heart failure and is linked to an increased risk of hospital admission and mortality. Among stroke patients, pre-stroke frailty is frequently observed and is associated with higher mortality, extended hospitalization, and stroke recurrence. Furthermore, the risk of sarcopenia and frailty is high in stroke survivors. Poststroke frailty is associated with increased mortality, hospital admissions, and stroke recurrence. Managing sarcopenia and frailty after stroke is crucial for improving patient outcomes. Multidisciplinary support, including aggressive rehabilitation, nutritional support, and continuous rehabilitation during the chronic stage, is important. As Japan is a super-aging country, effective management of sarcopenia and frailty, alongside disease treatment, is essential for further improving patient prognosis.

No abstract

Cardiovascular disease (CVD) is associated with a greater frailty risk, but it remains unknown if pathways that contribute to CVD are associated with the frailty risk. Thus, we aimed to investigate whether elevations in high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for those without known CVD at baseline are associated with a higher frailty risk. This study used data from the Atherosclerosis Risk in Communities study. Cardiac biomarkers were measured from stored plasma samples collected at Visit 2 (1991-1993). Frailty was recorded at Visit 5 (2011-2013). Cox regression models were used to determine the association of cardiac biomarkers with frailty risk. Overall, 360/5199 (6.9%) participants aged 55.1 ± 5.1 years developed frailty during a median follow-up of 21.7 years. The incidence of frailty was significantly higher in participants with hs-cTnT ≥14 ng/L (vs. < 14 ng/L: 17.9% vs. 6.7%) or NT-proBNP ≥300 pg/ml (vs. < 300 pg/ml: 19.7% vs. 6.8%) (all P < 0.001). Comparing higher vs. lower cut-off levels of either hs-cTnT (14 ng/l) or NT-proBNP (300 pg/ml) demonstrated a greater than two-fold higher frailty risk, with hazard ratios (HRs) of 2.13 (95% confidence interval (CI): 1.130-4.01, P = 0.020) and 2.61 (95% CI: 1.28-5.33, P = 0.008), respectively. Individuals with both elevated hs-cTnT and NT-proBNP had a higher frailty risk than those without it (HR: 4.15; 95% CI: 1.50-11.48, P = 0.006). High hs-cTnT and NT-proBNP levels are strongly associated with incident frailty in the community-dwelling population without known CVD. Subclinical cardiac damage (hs-cTnT) and/or wall strain (NT-proBNP) may be the key pathway of CVD patients developing frailty. Detection of hs-cTnT and NT-proBNP may help for early screening of high-risk frailty and providing individualised intervention. URL: https://www. gov ; Unique identifier: NCT00005131 .

Cardiac rehabilitation (CR) is an evidence-based, secondary preventive strategy that improves mortality and morbidity rates in patients with heart failure (HF). However, the implementation and continuation of CR remains unsatisfactory, particularly for outpatients with physical frailty. This study investigated the efficacy and safety of a comprehensive home-based cardiac rehabilitation (HBCR) programme that combines patient education, exercise guidance, and nutritional guidance using information and communication technology (ICT). This study was a single-centre, open-label, randomized, controlled trial. Between April 2020 and November 2020, 30 outpatients with chronic HF (New York Heart Association II-III) and physical frailty were enrolled. The control group (n = 15) continued with standard care, while the HBCR group (n = 15) also received comprehensive, individualized CR, including ICT-based exercise and nutrition guidance using ICT via a Fitbit® device for 3 months. The CR team communicated with each patient in HBCR group once a week via the application messaging tool and planned the training frequency and intensity of training individually for the next week according to each patient's symptoms and recorded pulse data during exercise. Dietitians conducted a nutritional assessment and then provided individual nutritional advice using the picture-posting function of the application. The primary outcome was the change in the 6 min walking distance (6MWD). The participants' mean age was 63.7 ± 10.1 years, 53% were male, and 87% had non-ischaemic heart disease. The observed change in the 6MWD was significantly greater in the HBCR group (52.1 ± 43.9 m vs. -4.3 ± 38.8 m; P < 0.001) at a 73% of adherence rate. There was no significant change in adverse events in either group. Our comprehensive HBCR programme using ICT for HF patients with physical frailty improved exercise tolerance and improved lower extremity muscle strength in our sample, suggesting management with individualized ICT-based programmes as a safe and effective approach. Considering the increasing number of HF patients with frailty worldwide, our approach provides an efficient method to keep patients engaged in physical activity in their daily life.

To describe the prevalence, overlap, and prognostic implications of physical and social frailties and cognitive dysfunction in hospitalized elderly patients with heart failure. The FRAGILE-HF study was a prospective multicentre cohort study enrolling consecutive hospitalized patients with heart failure aged ≥65 years. The study objectives were to examine the prevalence, overlap, and prognostic implications of the coexistence of multiple frailty domains. Physical frailty, social frailty, and cognitive dysfunction were evaluated by the Fried phenotype model, Makizako's 5 items, and Mini-Cog, respectively. The primary study outcome was the combined endpoint of heart failure rehospitalization and all-cause death within 1 year. Among 1180 enrolled hospitalized patients (median age, 81 years; 57.4% male), physical frailty, social frailty, and cognitive dysfunction were identified in 56.1%, 66.4%, and 37.1% of the patients, respectively. The number of identified frailty domains was 0, 1, 2, and 3 in 13.5%, 31.4%, 36.9%, and 18.2% of the patients, respectively. During follow-up, the combined endpoint occurred in 383 patients. Adjusted hazard ratios for 1, 2, and 3 domains, with 0 domains as the reference, were 1.38 [95% confidence interval (CI) 0.89-2.13; P = 0.15], 1.60 (95% CI 1.04-2.46; P = 0.034), and 2.04 (95% CI 1.28-3.24; P = 0.003), respectively. Incorporating the number of frailty domains into the pre-existing risk model yielded a 22.0% (95% CI 0.087-0.352; P = 0.001) net reclassification improvement for the primary outcome. The coexistence of multiple frailty domains is prevalent in hospitalized elderly patients with heart failure. Holistic assessment of multi-domain frailty provides additive value to known prognostic factors.

Frailty is common among older patients with acute decompensated heart failure (ADHF) and is associated with worse quality of life (QOL) and a higher risk of clinical events. Frailty can also limit recovery and response to interventions. In the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial, a 3-month innovative, early, transitional, tailored, multidomain physical rehabilitation intervention improved physical function and QOL (vs usual care) in older patients with ADHF. To evaluate whether baseline frailty modified the benefits of the physical rehabilitation intervention among patients with ADHF enrolled in the REHAB-HF trial and to assess the association between changes in frailty with the risk of adverse clinical outcomes on follow-up. This prespecified secondary analysis of the REHAB-HF trial, a multicenter randomized clinical trial, included 337 patients 60 years and older hospitalized for ADHF. Patients were enrolled from September 17, 2014, through September 19, 2019. Participants were stratified across baseline frailty strata as assessed using modified Fried criteria. Data were analyzed from July 2021 to September 2022. Physical rehabilitation intervention or attention control. Primary outcome was the Short Physical Performance Battery (SPPB) score at 3 months. Clinical outcomes included all-cause hospitalization or mortality at 6 months. This prespecified secondary analysis included 337 participants; 181 (53.7%) were female, 167 (49.6%) were Black, and the mean (SD) age was 72 (8) years. A total of 192 (57.0%) were frail and 145 (43.0%) were prefrail at baseline. A significant interaction was observed between baseline frailty status and the treatment arm for the primary trial end point of overall SPPB score, with a 2.6-fold larger improvement in SPPB with intervention among frail patients (2.1; 95% CI, 1.3-2.9) vs prefrail patients (0.8; 95% CI, -0.1 to 1.6; P for interaction = .03). Trends consistently favored a larger intervention effect size, with significant improvement among frail vs prefrail participants for 6-minute walk distance, QOL, and the geriatric depression score, but interactions did not achieve significance. In this prespecified secondary analysis of the REHAB-HF trial, patients with ADHF with worse baseline frailty status had a more significant improvement in physical function in response to an innovative, early, transitional, tailored, multidomain physical rehabilitation intervention than those who were prefrail. Clinical Trials.gov Identifier: NCT02196038.

No abstract

No abstract

Frailty is a severe, common co-morbidity associated with heart failure (HF) with preserved ejection fraction (HFpEF). The impact of frailty on HFpEF outcomes may affect treatment choices in HFpEF. The impact of frailty on HFpEF patients and any impact on the clinical benefits of sodium glucose co-transporter 2 (SGLT2) inhibition in HFpEF have been described in only a limited number of trials. Whether the SGLT2 inhibitor empagliflozin would improve or worsen frailty status when given to HFpEF patients is also not known. The aims of this study were, therefore, to evaluate, in HFpEF patients enrolled in the EMPEROR-Preserved trial (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction), the impact of frailty on clinical outcomes, and on the effects of empagliflozin, as well as the effect of empagliflozin on frailty status during treatment period. We calculated a cumulative deficit-derived frailty index (FI) using 44 variables including clinical, laboratory and quality of life parameters recorded in EMPEROR-Preserved. Patients were classified into four groups: non-frail (FI < 0.21), mild frailty (0.21 to <0.30), moderate frailty (0.30 to <0.40) and severe frailty (≥0.40). Clinical outcomes and health-related quality of life were evaluated according to baseline FI along with the effect of empagliflozin on chronological changes in FI (at 12, 32 and 52 weeks). The patient distribution was 1514 (25.3%), 2100 (35.1%), 1501 (25.1%) and 873 (14.6%) in non-frail, mild frailty, moderate frailty and severe frailty, respectively. Severe frailty patients tended to be female and have low Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, more co-morbidities and more polypharmacy. Incidence rates of the primary outcome of cardiovascular death or HF hospitalization increased as frailty worsened (hazard ratio [HR] of each FI category compared with the non-frail group: 1.10 [95% confidence interval, CI, 0.89-1.35], 2.00 [1.63-2.47] and 2.61 [2.08-3.27] in the mild frailty, moderate frailty and severe frailty groups, respectively; P trend < 0.001). Compared with placebo, empagliflozin reduced the risk for the primary outcome across the four FI categories, HR: 0.59 [95% CI 0.42-0.83], 0.79 [0.61-1.01], 0.77 [0.61-0.96] and 0.90 [0.69-1.16] in non-frail to severe frailty categories, respectively (P value for trend = 0.097). Empagliflozin also improved other clinical outcomes and KCCQ score across frailty categories. Compared with placebo, empagliflozin-treated patients had a higher likelihood of being in a lower FI category at Weeks 12, 32 and 52 (P < 0.05), odds ratio: 1.12 [95% CI 1.01-1.24] at Week 12, 1.21 [1.09-1.34] at Week 32 and 1.20 [1.09-1.33] at Week 52. Empagliflozin improved key efficacy outcomes with a possible diminution of effect in very frail patients. Empagliflozin also improved frailty status during follow-up.

No abstract

Frailty is increasing in prevalence. Because patients with frailty are often perceived to have a less favorable risk/benefit profile, they may be less likely to receive new pharmacologic treatments. We investigated the efficacy and tolerability of dapagliflozin according to frailty status in patients with heart failure with mildly reduced or preserved ejection fraction randomized in DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure). Frailty was measured using the Rockwood cumulative deficit approach. The primary end point was time to a first worsening heart failure event or cardiovascular death. Of the 6263 patients randomized, a frailty index (FI) was calculable in 6258. In total, 2354 (37.6%) patients had class 1 frailty (FI ≤0.210; ie, not frail), 2413 (38.6%) had class 2 frailty (FI 0.211-0.310; ie, more frail), and 1491 (23.8%) had class 3 frailty (FI ≥0.311; ie, most frail). Greater frailty was associated with a higher rate of the primary end point (per 100 person-years): FI class 1, 6.3 (95% CI 5.7-7.1); class 2, 8.3 (7.5-9.1); and class 3, 13.4 (12.1-14.7; In DELIVER, frailty was common and associated with worse outcomes. The benefit of dapagliflozin was consistent across the range of frailty studied. The improvement in health-related quality of life with dapagliflozin occurred early and was greater in patients with a higher level of frailty. URL: https://www. gov; Unique identifier: NCT03619213.

Frailty may modify the risk-benefit profile of certain treatments, and frail patients may have reduced tolerance to treatments. To investigate the efficacy of dapagliflozin according to frailty status, using the Rockwood cumulative deficit approach, in DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure). Post hoc analysis of a phase 3 randomized clinical trial. (ClinicalTrials.gov: NCT03036124). 410 sites in 20 countries. Patients with symptomatic heart failure (HF) with a left ventricular ejection fraction of 40% or less and elevated natriuretic peptide. Addition of once-daily 10 mg of dapagliflozin or placebo to guideline-recommended therapy. The primary outcome was worsening HF or cardiovascular death. Of the 4744 patients randomly assigned in DAPA-HF, a frailty index (FI) was calculable in 4742. In total, 2392 patients (50.4%) were in FI class 1 (FI ≤0.210; not frail), 1606 (33.9%) in FI class 2 (FI 0.211 to 0.310; more frail), and 744 (15.7%) in FI class 3 (FI ≥0.311; most frail). The median follow-up time was 18.2 months. Dapagliflozin reduced the risk for worsening HF or cardiovascular death, regardless of FI class. The differences in event rate per 100 person-years for dapagliflozin versus placebo from lowest to highest FI class were -3.5 (95% CI, -5.7 to -1.2), -3.6 (CI, -6.6 to -0.5), and -7.9 (CI, -13.9 to -1.9). Consistent benefits were observed for other clinical events and health status, but the absolute reductions were generally larger in the most frail patients. Study drug discontinuation and serious adverse events were not more frequent with dapagliflozin than placebo, regardless of FI class. Enrollment criteria precluded the inclusion of very high-risk patients. Dapagliflozin improved all outcomes examined, regardless of frailty status. However, the absolute reductions were larger in more frail patients. AstraZeneca.

No abstract

The study aims (1) to provide a contemporary description of frailty assessment in heart failure and (2) to provide an overview of multi-domain frailty assessment in heart failure. Frailty assessment is an important predictive measure for mortality and hospitalisation in individuals with heart failure. To date, there are no frailty assessment instruments validated for use in heart failure. This has resulted in significant heterogeneity between studies regarding the assessment of frailty. The most common frailty assessment instrument used in heart failure is the Frailty Phenotype which focuses on five physical domains of frailty; the appropriateness a purely physical measure of frailty in individuals with heart failure who frequently experience decreased exercise tolerance and shortness of breath is yet to be determined. A limited number of studies have approached frailty assessment using a multi-domain view which may be more clinically relevant in heart failure. There remains a lack of consensus regarding frailty assessment and an absence of a validated instrument in heart failure. Despite this, frailty continues to be assessed frequently, primarily for research purposes, using predominantly physical frailty measures. A more multidimensional view of frailty assessment using a multi-domain approach will likely be more sensitive to identifying at risk patients.

No abstract

No abstract

Frailty, a clinical syndrome that typically occurs in older adults, implies a reduced ability to tolerate biological stressors. Frailty accompanies many age-related diseases but can also occur without overt evidence of end-organ disease. The condition is associated with circulating inflammatory cytokines and sarcopenia, features that are shared with heart failure (HF). However, the biological underpinnings of frailty remain unclear and the interaction with HF is complex. Here, we describe the inflammatory pathophysiology that is associated with frailty and speculate that the inflammation that occurs with frailty shares common origins with HF. We discuss the limitations in investigating the pathophysiology of frailty due to few relevant experimental models. Leveraging current therapies for advanced HF and current known therapies to address frailty in humans may enable translational studies to better understand the inflammatory interactions between frailty and HF.

No abstract

Recent data from major noncardiac surgery suggest that outcomes in frail patients are better predicted by a hospital's volume of frail patients specifically, rather than overall surgical volume. We sought to evaluate this "frailty volume-frailty outcome relationship" in patients undergoing cardiac surgery. We studied 72,818 frail patients undergoing coronary artery bypass grafting or valve replacement surgery from 2010 to 2014 using the Nationwide Readmissions Database. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. Multilevel logistic regression was used to assess the independent effect of frailty volume by quartile on mortality, surgical complications, failure to rescue, nonhome discharge, 30-day readmissions, length of stay, and hospital costs in frail patients. In comparing the highest volume quartiles with the lowest, both overall cardiac surgical volume and volume for frail patients were significantly associated with shorter length of stay and reduced costs. However, frailty volume was also independently associated with significantly reduced in-hospital mortality (odds ratio, 0.79; 95% confidence interval, 0.67-0.94; P = .006) and failure to rescue (odds ratio, 0.83; 95% confidence interval, 0.70-0.98; P = .03), whereas no such association was seen between overall volume and either mortality (odds ratio, 0.94; 95% confidence interval, 0.74-1.10; P = .43) or failure to rescue (odds ratio, 0.98; 95% confidence interval, 0.83-1.17; P = .85). Neither frailty volume nor overall volume showed any significant relationship with the rate of 30-day readmissions. In frail patients undergoing cardiac surgery, surgical volume of frail patients was a significant independent of predictor of in-hospital mortality and failure to rescue, whereas overall surgical volume was not. Thus, the "frailty volume-outcome relationship" superseded the traditional "volume-outcome relationship" in frail patients with cardiac disease.

The atherogenic index of plasma (AIP) is a marker of atherosclerosis, while frailty reflects cumulative physiological decline. However, the combined impact of AIP-frailty index (AIP-FI) has not been adequately explored. This study aimed to investigate the association between AIP-FI and the risk of cardiovascular disease (CVD), stroke, and heart disease. This prospective cohort study included 6896 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study (CHARLS) without CVD, stroke, or heart disease at baseline. The Cox proportional hazard models and restricted cubic spline (RCS) analysis were applied to explore the association between AIP-FI with the risk of CVD, stroke, and heart disease. During a median follow-up period of 9 years, 1648 (23.9%) of CVD events, 548 (7.9%) of stroke events, and 1280 (18.6%) of heart disease events were recorded. Cox regression analysis revealed that each 1-unit increment in the AIP-FI was significantly associated with higher risk of CVD (HR: 2.95, 95% CI 2.15, 4.05), stroke (HR: 3.14, 95% CI 1.88, 5.26), and heart disease (HR: 2.72, 95% CI 1.06, 1.89, 3.92). The RCS revealed a significant positive nonlinear relationship between AIP-FI with the risk of CVD, stroke, and heart disease (all P-overall < 0.05, and all P for non-linear < 0.05). Our study demonstrated that higher AIP-FI was significantly associated with increased risk of CVD, stroke, and heart disease. By integrating metabolic and frailty information, AIP-FI offers an effective and accessible tool for cardiovascular risk assessment, supporting earlier prevention and intervention strategies in the middle-aged and elderly Chinese populations.

Physical prehabilitation can enhance patient resilience to surgical stress, but its effects are unclear in vulnerable and frail patients. We aimed to determine the effect of a structured exercise prehabilitation programme on the quality of recovery after cardiac surgery in vulnerable and frail participants. This single-blinded, parallel-arm, superiority, randomised controlled trial recruited patients with a Clinical Frailty Scale of 4-6 undergoing cardiac surgery. Patients were randomised to either physical prehabilitation (twice weekly) or standard care (control); both arms received standard perioperative care. The primary outcome was Quality of Recovery-15 (QoR-15) score on the third day after surgery. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE), days alive and at home (DAH Of 164 randomised patients, 138 were included in the primary analysis (median age 64 [interquartile range 60-69] yr; 70% males). Compliance with the 5-week prehabilitation programme was high (82%), with no adverse exercise-induced events reported. There were no between-group differences in QoR-15 scores (median difference -3, 95% confidence interval [CI] -9 to 3), early and late MACCE, and DAH A 5-week programme of physical prehabilitation in predominately prefrail patients was safe, but it did not enhance quality of recovery scores after surgery. Prehabilitation resulted in a clinically meaningful decrease in disability scores at 90 days after surgery. ChiCTR1800016098.

Although frailty has been associated with major morbidity/mortality and increased length of stay after cardiac surgery, few studies have examined functional outcomes. We hypothesized that frailty would be independently associated with decreased functional status, increased discharge to a nonhome location, and longer duration of hospitalization after cardiac surgery, and that delirium would modify these associations. This was an observational study nested in 2 trials, each of which was conducted by the same research team with identical measurement of exposures and outcomes. The Fried frailty scale was measured at baseline. The primary outcome (defined before data collection) was functional decline, defined as ≥2-point decline from baseline in Instrumental Activities of Daily Living (IADL) score at 1 month after surgery. Secondary outcomes were absolute decline in IADL score, discharge to a new nonhome location, and duration of hospitalization. Associations were analyzed using linear, logistic, and Poisson regression models with adjustments for variables considered before analysis (age, gender, race, and logistic European Score for Cardiac Operative Risk Evaluation [EuroSCORE]) and in a propensity score analysis. Data were available from 133 patients (83 from first trial and 50 from the second trial). The prevalence of frailty was 33% (44 of 133). In adjusted models, frail patients had increased odds of functional decline (primary outcome; odds ratio [OR], 2.41 [95% confidence interval {CI}, 1.03-5.63]; P = .04) and greater decline at 1 month in the secondary outcome of absolute IADL score (-1.48 [95% CI, -2.77 to -0.30]; P = .019), compared to nonfrail patients. Delirium significantly modified the association of frailty and change in absolute IADL score at 1 month. In adjusted hypothesis-generating models using secondary outcomes, frail patients had increased discharge to a new nonhome location (OR, 3.25 [95% CI, 1.37-7.69]; P = .007) and increased duration of hospitalization (1.35 days [95% CI, 1.19-1.52]; P < .0001) compared to nonfrail patients. The increased duration of hospitalization, but no change in functional status or discharge location, was partially mediated by increased complications in frail patients. Frailty may identify patients at risk of functional decline at 1 month after cardiac surgery. Perioperative strategies to optimize frail cardiac surgery patients are needed.

Frailty is common in heart failure with preserved ejection fraction (HFpEF). In the STEP-HFpEF (Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity) program, semaglutide improved heart failure (HF) symptoms and physical limitations and reduced body weight (BW) in participants with obesity-related HFpEF. Whether the efficacy and safety of semaglutide vary by frailty and the effects of semaglutide on frailty are unknown. This study sought to evaluate the efficacy of semaglutide in participants with obesity-related HFpEF according to frailty status at baseline. The authors performed a prespecified, pooled, participant-level analysis of the STEP-HFpEF program that included participants with obesity-related HFpEF. Participants were randomized to once-weekly semaglutide, 2.4 mg, or placebo for 52 weeks. Dual primary endpoints were changes in Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS) and BW. Frailty was estimated using a cumulative deficit-derived frailty index comprising 34 variables across multiple domains at baseline and follow-up. Efficacy and safety of semaglutide were evaluated in participants across 3 baseline frailty strata. Effects of semaglutide on frailty burden were also assessed. Of the 1,145 participants, 110 (9.6%) were nonfrail, 343 (30.0%) were more frail, and 692 (60.4%) were most frail. Semaglutide-mediated weight loss was similar across frailty strata (P Semaglutide resulted in a similar reduction in BW across frailty subgroups but greater improvements in HF-related symptoms. Moreover, semaglutide reduced frailty burden after 52 weeks of treatment. (Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity [STEP-HFpEF]; NCT04788511) (Research Study to Look at How Well Semaglutide Works in People Living With Heart Failure, Obesity and Type 2 Diabetes [STEP-HFpEF DM]; NCT04916470).

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to improve renal and cardiovascular outcomes in patients with type 2 diabetes. Limited evidence exists about the efficacy and safety of SGLT2 inhibitors in patients with frailty. This was a post hoc pooled, participant-level data analysis of the CANVAS Program (CANVAS and CANVAS-R) and the CREDENCE trial. We examined the effect of canagliflozin on: (1) Major adverse cardiovascular events (MACE), (2) Cardiovascular mortality, (3) all-cause mortality, and (4) key safety outcomes. Frailty was defined by a Frailty Index (FI) based on a deficit accumulation approach (FI > 0.25: frail). Cox proportional-hazard models were used to estimate the efficacy and safety of canagliflozin overall and according to frailty status. There were 14,543 participants (10,142 from the CANVAS Program, 4401 from the CREDENCE trial). Their mean age was 63.2 years; 35.3% were female. Frailty was present in 56% of the study participants. The benefits of canagliflozin were observed in both the frail and non-frail subgroups: HRs for MACE 0.80 (95% CI 0.70-0.90) in the frail versus 0.91 (95% CI 0.75-1.09) in the non-frail (p for interaction = 0.27); HRs for cardiovascular mortality 0.79 (95% CI 0.67-0.95) in the frail versus 0.94 (95% CI 0.70-1.27) in the non-frail (p for interaction = 0.38); HRs for all-cause mortality 0.81 (95% CI 0.70-0.94) in the frail versus 0.93 (95% CI 0.74-1.16) in the non-frail (p for interaction = 0.39). Adverse events were similar among frail and non-frail participants, except for osmotic diuresis (HRs 1.67, 95% CI 1.22-2.28 in the frail vs. 3.05, 95% CI 2.13-4.35 in the non-frail, p for interaction = 0.01). Canagliflozin improved cardiovascular and mortality endpoints in participants with type 2 diabetes irrespective of frailty status, with a similar safety profile. Our findings, in addition to those from other recent studies, provide evidence to support the introduction of SGLT2 inhibitor therapy in patients perceived to be frail. ClinicalTrials.gov CANVAS: NCT01032629; CANVAS-R: NCT01989754; CREDENCE: NCT02065791.

No abstract

The benefits of cardiac rehabilitation (CR) are well-suited to counteract the deficits of frailty such as sarcopenia, inactivity, fatigue, cognitive decline, and depression. After a cardiovascular hospitalization, older patients are at increased risk for deconditioning and functional decline and thus should be evaluated for frailty and targeted for early CR referral. At the initial CR visit, frail older patients should undergo a 6-minute walk test and short physical performance battery to tailor their aerobic and resistance exercise plan, and they should be screened for geriatric impairments and environmental barriers to facilitate their participation in centre-based or home-based CR.

No abstract