Frailty Is Intertwined With Heart FailureMechanisms, Prevalence, Prognosis, Assessment, and Management
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click the login link or the subscribe link in the top menu above to access this article.
Author + information
- Ambarish Pandey, MD, MSCSa,
- Dalane Kitzman, MDb and
- Gordon Reeves, MD, MPTc,∗ (grreeves{at}novanthealth.org)
- aDivision of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
- bSections on Cardiovascular Medicine and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
- cNovant Health Heart & Vascular Institute, Charlotte, North Carolina
- ↵∗Address for correspondence:
Dr. Gordon Reeves, Novant Health Heart & Vascular Institute, 1718 East 4th Street, Suite 501, Charlotte, North Carolina 28204.
Central Illustration
Highlights
• Frailty is common in older patients with heart failure, and both frailty and heart failure share common mechanistic features, including strong relations with a high burden of comorbidities, inflammation, and sarcopenia.
• Frailty is associated with worse clinical, functional, and quality of life outcomes in older patients with heart failure.
• Frailty should be considered for routine assessment by using well-validated assessment tools to better inform prognosis.
• In older patients with heart failure and frailty, novel management strategies, such as those addressing multiple domains through multidisciplinary assessment and intervention, should be investigated further.
Abstract
Frailty, a syndrome characterized by an exaggerated decline in function and reserve of multiple physiological systems, is common in older patients with heart failure (HF) and is associated with worse clinical and patient-reported outcomes. Although several detailed assessment tools have been developed and validated in the geriatric population, they are cumbersome, not validated in patients with HF, and not commonly used in routine management of patients with HF. More recently, there has been an increasing interest in developing simple frailty screening tools that could efficiently and quickly identify frail patients with HF in routine clinical settings. As the burden and recognition of frailty in older patients with HF increase, a more comprehensive approach to management is needed that targets deficits across multiple domains, including physical function and medical, cognitive, and social domains. Such a multidomain approach is critical to address the unique, multidimensional challenges to the care of these high-risk patients and to improve their functional status, quality of life, and long-term clinical outcomes. This review discusses the burden of frailty, the conceptual underpinnings of frailty in older patients with HF, and potential strategies for the assessment, screening, and management of frailty in this vulnerable patient population.
Footnotes
Dr. Kitzman is supported in part by the National Institutes of Health (NIH) research grants R01AG045551 and R01AG18915, the Kermit Glenn Phillips II Chair in Cardiovascular Medicine at Wake Forest School of Medicine, the Claude D. Pepper Older Americans Independence Center NIH Grants P30AG021332 and P30AG028716, the OAIC Pepper National Coordinating Center NIH Grant U24 AG05964, and the Wake Forest Clinical and Translational Science Award, NIH Grant UL1TR001420. Dr. Pandey is supported by the Texas Health Resources Clinical Research Scholarship. Dr. Kitzman has been a consultant for AbbVie, AstraZeneca, Merck, Novartis, Corvia Medical, Bayer, CinRx, Boehringer Ingelheim, and St. Luke’s Medical Center; received grant support from Novartis, Bayer, AstraZeneca, and St. Luke’s Medical Center; and owns stock in Gilead Sciences. Dr. Reeves has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received August 7, 2019.
- Revision received October 15, 2019.
- Accepted October 15, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.
