Frailty is a clinical syndrome characterised by multisystem impairment which decreases physiological reserve and increases the vulnerability to stressors. In patients with cardiovascular disease, frailty is a strong independent predictor of reduced life expectancy, prolonged hospitalisation and complications from surgery and other interventions.1 For these reasons there has been an increasing interest in the role of more systematic evaluation for frailty in elderly patients considered for major cardiovascular interventions.2

In their published Heart paper, Ramsay and colleagues3 provide a different perspective on the links between frailty and cardiovascular disease. In a large cohort of men aged 71–92 years from the British Regional Heart Study, frailty was associated with history of myocardial infarction, stroke, heart failure, peripheral vascular disease and deep venous thrombosis. Markers of poorer general health including poor renal function, a high white blood cell count, low haemoglobin, low …