This week we published a review in the Journal Current Cardiovascular Risk Reports on the concept of frailty and advanced heart failure in older adults. As geriatricians have long known, frailty–defined as an increased vulnerability to physiologic stressors–is an incredibly common and often unrecognized syndrome in older patients. Cardiologists are increasingly recognizing that frailty predicts a broad range of outcomes, including mortality, in conditions such as heart failure, but also other situations such as acute myocardial infarction and transcatheter aortic valve replacement.
A few highlights from our paper:
– 80% of patients with heart failure are over age 65.
– As the heart failure population continues to age, the burden of frailty has increased.
– The estimated prevalence of frailty in advanced heart failure varies widely, with some estimates ranging up to 3 out of every 4 patients.
– It is challenging to determine causality between heart failure and frailty; they share common inflammatory pathways and one syndrome may mimic the other.
With our current technologies, one of the most pressing clinical questions is whether placement of a left ventricular assist device (LVAD) in advanced systolic heart failure can reverse the frailty phenotype, by correcting underlying physiologic derangements. Flint et al. have put forward the concept of “LVAD-responsive frailty” and “LVAD-independent frailty” – with an illustrative figure cited in our paper. Their concept emphasizes the considerable heterogeneity that exists within heart failure populations. We will need further studies to be able to predict where frailty may improve, in order to better counsel patients about their expected outcomes.
By: John Dodson