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Frailty assessment in the management of cardiovascular disease
  1. Chris Wilkinson1,2,3,
  2. Kenneth Rockwood4
  1. 1Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, Tyne and Wear, UK
  2. 2Hull York Medical School, University of York, York, North Yorkshire, UK
  3. 3Academic Cardiovascular Unit, South Tees NHS Foundation Trust, Middlesbrough, UK
  4. 4Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  1. Correspondence to Dr Chris Wilkinson, Hull York Medical School, University of York, York, UK; c.wilkinson{at}york.ac.uk

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Learning objectives

  • To gain an appreciation of the importance and clinical impact of frailty on patients with cardiovascular disease.

  • To understand how to evaluate frailty in the clinic or the ward.

  • To consider how you might integrate frailty assessment into your routine practice.

Introduction

The marked heterogeneity in how ageing is experienced between individuals means that chronological age alone is insufficient for clinicians to identify patients who are at risk of a poor clinical outcome when they become unwell.1 Frailty describes vulnerability to poor resolution of homeostasis after a stressor event.1 It results from cumulative decline in multiple physiological systems, and is observed in 12%–24% of older adults.1 2 Frailty is particularly common in those with cardiovascular disease, and a combination of population ageing and increased survivorship of cardiovascular disease means that cardiologists will be caring for increasingly complex patients, who are living with varying degrees of frailty.3–5 Recognising that frailty is not a dichotomous variable is crucial; without that, frailty can become the polite face of ageism.

Understanding the degree of frailty present in individuals helps clinicians to estimate how much a new condition is likely to affect their patient, allowing them to better estimate the likely prognosis for people of the same age.6 It is useful in guiding individualised treatment of people with cardiovascular disease, including weighing up risks and benefits with greater precision, guiding person-oriented decisions in what levels of intervention are appropriate. By understanding the size of the gap between what the patients look like when ill and their baseline health, it also signals the need for rehabilitation and other follow-up care (figure 1).7

Figure 1

What is frailty good for?

What does frailty add to clinical assessment?

Clinical decision-making fundamentally boils down to evaluating probabilities. For example, what are the chances that this patient with chest pain is having an …

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Footnotes

  • Twitter @wilkinsoncg, @https://www.twitter.com/Krockdoc

  • Contributors CW and KR co-authored this work.

  • Funding CW was funded by the NIHR Research Trainees Coordinating Centre (Academic Clinical Lecturer).

  • Competing interests CW has received a research grant from Bristol Myers Squibb. Through Dalhousie University, KR has asserted copyright of the Clinical Frailty Scale. It is free for research, education and not-for-profit healthcare. Users are asked to indicate that they will not change or commercialise it.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note References which include a * are considered to be key references.