Frailty assessment in the management of cardiovascular disease

Cardiogeriatrics: the current state of the art

It is estimated that by 2050, 17% of the world's population will be greater than 85 years old, which, combined with cardiovascular disease (CVD) being the leading cause of death and disability, sets an unprecedented burden on our health and care systems. This perfect storm will be accompanied by a rise in the prevalence of CVD due to increased survival of patients with pre-existing CVD and the incidence of CVD that is associated with the process of ageing. In this review, we will focus on the diagnosis and management of common CVD conditions in old age, namely: heart failure (HF), coronary artery disease (CAD), atrial fibrillation (AF) and valvular heart disease (VHD). Despite limited evidence, clinical guidelines are increasingly considering the complexity of management of these conditions in the older person, which often coexist, for example, AF and HF or CAD and VHD. Furthermore, they, in turn, need specific consideration in the context of comorbidities, polypharmacy, frailty and impaired cognition found in this age group. Hence, the emerging role of the geriatric cardiologist is therefore vital in performing comprehensive geriatric assessment, attending multidisciplinary team meetings and ultimately considering the patient and the sum of their diseases in their totality. There have been recent advances in CVD management but how we apply these to deliver integrated care to the elderly population is key. This review article aims to bring together emerging studies and guidelines on assessment and management of CVD in the elderly, summarising latest definitions, diagnostics, therapeutics and future challenges.

Feasibility study of rehabilitation for cardiac patients aided by an artificial intelligence web-based programme: a randomised controlled trial (RECAP trial)-a study protocol

INTRODUCTION

Cardiac rehabilitation (CR) delivered by rehabilitation specialists in a healthcare setting is effective in improving functional capacity and reducing readmission rates after cardiac surgery. It is also associated with a reduction in cardiac mortality and recurrent myocardial infarction. This trial assesses the feasibility of a home-based CR programme delivered using a mobile application (app).

METHODS

The Rehabilitation through Exercise prescription for Cardiac patients using an Artificial intelligence web-based Programme (RECAP) randomised controlled feasibility trial is a single-centre prospective study, in which patients will be allocated on a 1:1 ratio to a home-based CR programme delivered using a mobile app with accelerometers or standard hospital-based rehabilitation classes. The home-based CR programme will employ artificial intelligence to prescribe exercise goals to the participants on a weekly basis. The trial will recruit 70 patients in total. The primary objectives are to evaluate participant recruitment and dropout rates, assess the feasibility of randomisation, determine acceptability to participants and staff, assess the rates of potential outcome measures and determine hospital resource allocation to inform the design of a larger randomised controlled trial for clinical efficacy and health economic evaluation. Secondary objectives include evaluation of health-related quality of life and 6 minute walk distance.

ETHICS AND DISSEMINATION

RECAP trial received a favourable outcome from the Berkshire research ethics committee in September 2022 (IRAS 315483).Trial results will be made available through publication in peer-reviewed journals and presented at relevant scientific meetings.

TRIAL REGISTRATION NUMBER

ISRCTN97352737.

Association of estimated carotid-femoral pulse wave velocity with frailty in middle-aged and older adults with cardiometabolic disease

PURPOSE

The prevalence of frailty in individuals with cardiometabolic disease (CMD) has become a growing concern in public health. The purpose of this study was to investigate the association between estimated pulse wave velocity (ePWV) and frailty in middle-aged and older adults with CMD.

METHODS

We analyzed data from 23,313 non-institutionalized adults with CMD from the National Health and Nutrition Examination Survey 2003-2018. Frailty status was determined using the frailty index, and logistic regression models were used to assess the association of ePWV with frailty risk. Multivariable logistic regression and propensity-score matching (PSM) were used to adjust for potential confounders. The restricted cubic spline regression model was used to evaluate the non-linear association between ePWV and frailty risk.

RESULTS

After adjusting for potential confounding factors, we found that each one m/s increase in ePWV was associated with a 15% higher risk of frailty (odds ratio [OR] = 1.15, 95% confidence interval [CI] 1.12 to 1.18, P < 0.001). After PSM, the association remained significant (OR = 1.05, 95% CI 1.03 to 1.08, P < 0.001). The logistic models with restricted cubic splines showed a non-linear dose-response association, with the risk of frailty increasing more rapidly when ePWV exceeded 9.5 m/s.

CONCLUSIONS

The findings of this study suggest that a higher level of ePWV is associated with an increased risk of frailty in middle-aged and older adults with CMD, and may serve as a viable alternative to directly measured cfPWV.

Impact of Frailty on Clinical Outcomes in Patients With Atrial Fibrillation Who Underwent Cardiac Ablation Using a Nationwide Database

This study aimed to assess the association between frailty and clinical outcomes in patients with atrial fibrillation (AF) who undergo catheter ablation. We conducted a retrospective cohort study using the National Inpatient Sample database from 2017 to 2019. Adult patients hospitalized with a primary diagnosis of AF who underwent catheter ablation were included. Frailty was assessed using the Hospital Frailty Risk Score. The primary outcome was the presence of any complication (vascular, cardiac, respiratory, neurologic, or infectious), and secondary outcomes were in-hospital mortality, length of hospital stay, and hospital charges. A total of 21,075 weighted hospitalizations were included, and 14% were classified as intermediate or great risk of frailty. Patients with intermediate (adjusted relative risk 2.86, 95% confidence interval 2.24 to 3.67) and great (adjusted relative risk 6.68, 95% confidence interval 3.77 to 11.84) risk of frailty were associated with a greater risk of any complication than that of the group at less risk. The in-hospital mortality rate was significantly higher among patients at intermediate risk than among those at less risk of frailty (2.6% vs 0.1%, p <0.001). Patients with great and intermediate risk had significantly longer hospital stays than did the group with less risk (median 14 vs 5 vs 2 days, p <0.001), in addition to greater total charges (median $189,072 vs $161,598 vs $130,672, p <0.001), respectively. In conclusion, frailty was associated with a greater risk of poor short-term outcomes in patients with AF who underwent catheter ablation. The Hospital Frailty Risk Score is a useful tool for identifying patients at increased risk of adverse events and could aid in preoperative optimization and postoperative management.