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Impact of frailty on disease-specific health status in cardiovascular disease
  1. Dan D Nguyen1,2,
  2. Suzanne V Arnold1,2
  1. 1Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
  2. 2Department of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
  1. Correspondence to Dr Suzanne V Arnold, Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA; sarnold{at}


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.

  • atrial fibrillation
  • coronary artery disease
  • heart failure
  • heart valve diseases
  • peripheral vascular diseases

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  • Contributors Both authors contributed to all parts of the manuscript development, including literature research, drafting the manuscript and making critical revisions to the manuscript.

  • Funding Dr. Nguyen is supported by the National Heart, Lung, and Blood Institutes of Health Under Award Number T32HL110837

  • Competing interests SA is an editorial board member of Heart.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.