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Interventions for Frailty Among Older Adults With Cardiovascular Disease
Open accessAbstract
With the aging of the world's population, a large proportion of patients seen in cardiovascular practice are older adults, but many patients also exhibit signs of physical frailty. Cardiovascular disease and frailty are interdependent and have the same physiological underpinning that predisposes to the progression of both disease processes. Frailty can be defined as a phenomenon of increased vulnerability to stressors due to decreased physiological reserves in older patients and thus leads to poor clinical outcomes after cardiovascular insults. There are various pathophysiologic mechanisms for the development of frailty: cognitive decline, physical inactivity, poor nutrition, and lack of social supports; these risk factors provide opportunity for various types of interventions that aim to prevent, improve, or reverse the development of frailty syndrome in the context of cardiovascular disease. There is no compelling study demonstrating a successful intervention to improve a global measure of frailty. Emerging data from patients admitted with heart failure indicate that interventions associated with positive outcomes on frailty and physical function are multidimensional and include tailored cardiac rehabilitation. Contemporary cardiovascular practice should actively identify patients with physical frailty who could benefit from frailty interventions and aim to deliver these therapies in a patient-centered model to optimize quality of life, particularly after cardiovascular interventions.
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“Malnutrition, cachexia, sarcopenia, and frailty are phenotypically distinct but interconnected conditions with interrelated pathophysiological processes that lead to different magnitudes of wasting and susceptibility to adverse outcomes.81–83”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [83]
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“loss together with loss of MM and strength that makes older adults susceptible to disability.(4) The etiology of”
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“80 However, the lack of consensus on the best tool for routine clinical use presents challenges, including in the translation of research findings into clinical practice.”
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“Physical and nutritional interventions for frailty should also improve the outcomes of underweight patients.(28) STUDY LIMITATIONS.”
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“There is increasing interest among specialties to use frailty in clinical care to identify patients at increased risk for adverse events [8, 9].”
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“10”
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Fountotos, R., Ahmad, F., Bharaj, N., Munir, H., Marsala, J., Rudski, L., Goldfarb, M., & Afilalo, J. (2023) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18228 · Cited by 21
“The extent to which these interventions are feasible and effective in hospitalized CVD patients remains uncertain.(13) Thus, the MulTicomponent Acute Intervention in FRail GEriatric PaTients with CVD using the Essential Frailty Toolset (TARGET-EFT) randomized clinical trial was designed to address this knowledge gap.”
MethodSu, J. J., Wong, A. K. C., He, X.-F., Zhang, L.-P., Cheng, J., Lu, L., Lan, L., Wang, Z., Lin, R. S. Y., & Baťalík, L. (2024) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2024.101365 · Cited by 22
“The inclusion criteria were [1]: adults aged ≥ 60 [2], diagnosed with CHD [4], able to communicate and read Chinese [5], owning a smart-phone, and [6] having no prescribed physical activity restriction.”
BackgroundAhmad, F., Fountotos, R., Goldfarb, M., Bharaj, N., Munir, H., Marsala, J., Rudski, L., & Afilalo, J. (2022) · European Heart Journal - Quality of Care and Clinical Outcomes · doi:10.1093/ehjqcco/qcac050 · Cited by 18
Grieco, D., Bressi, E., Sedláček, K., Čurila, K., Vernooy, K., Fedele, E., Ruvo, E. D., Fagagnini, A., Kron, J., Padala, S. K., et al. (2022) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-022-01174-4 · Cited by 17
Won, M. H., Choi, J., & Son, Y. (2022) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvac074 · Cited by 17
Holistic frailty prevention: The promise of movement‐based mind–body therapies
Loewenthal, J., Berning, M. J., Wayne, P. M., Eckstrom, E., & Orkaby, A. R. (2023) · Aging Cell · doi:10.1111/acel.13986 · Cited by 19
“Over 60 tools have been developed to measure frailty for both clinical and research purposes, and most derive from either the Fried or Rockwood approach (Ijaz et al., 2022).”
MethodQu, J., Liang, Y., Rao, Y., Pei, Y., Li, D., Zhang, Y., Chen, Y., & Sun, Y. (2023) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2023.105310 · Cited by 16
Bakhtiari, M., Shaker, F., Shirmard, F. O., Jalali, A., Vakili‐Basir, A., Balabandian, M., Khamene, S. S., Khawajah, I. M., Shafiee, A., Badrkhahan, S. Z., et al. (2024) · BMC Cardiovascular Disorders · doi:10.1186/s12872-024-03781-7 · Cited by 16
“Several mechanisms contribute to frailty development, such as poor nutritional support, physical dormancy, and cognitive decline, as well as comorbidities such as hypertension and diabetes mellitus [6, 8].”
BackgroundYuguchi, T., Nakajima, K., Takaoka, H., & Shimokawa, T. (2024) · Circulation Reports · doi:10.1253/circrep.cr-24-0009 · Cited by 17
“15 The CGA instruments (BI, MMSE, CCI, and CONUT) used in the present study are representative CGA instruments for each frailty domain.”
MethodXiong, Y.-J., Meng, X., Xu, H., & Zhu, X.-Y. (2024) · Acta Diabetologica · doi:10.1007/s00592-024-02348-4 · Cited by 16
“Extended author information available on the last page of the article psychosocial deficits [3].”
Arauna, D., Navarrete, S., Cecilia Albala, B., Wehinger, S., Pizarro-Mena, R. A., Palomo, I. F., & Eduardo Fuentes, Q. (2024) · Biomedicines · doi:10.3390/biomedicines12092004 · Cited by 15
“Also, frailty has a significant social component, with social isolation, depression, and a decline in the support network of family or friends increasing the risk of developing this syndrome [3].”
BackgroundInfluentialLiu, A., Lin, Y.-X., Li, G., Meng, T., Tian, P., Chen, J., Zhang, X., Xu, W., Zhang, Y. X., Zhang, D., et al. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-05752-9 · Cited by 16
“Nota-bly, the risk of CVD escalates with aging, underscoring the importance for CVD older adults to actively identify frailty and cognitive impairment [47, 50].”
Vest, A. R., DiDomenico, R. J., Lichtenstein, L., Slater, T., Ekpo, E., Damluji, A. A., Bohula, E., Alviar, C. L., on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, & Council on Cardiovascular and Stroke Nursing (2026) · Circulation · doi:10.1161/cir.0000000000001405 · Cited by 15
Self-citationPatient-Reported Frailty and Functional Status in Heart Failure With Preserved Ejection Fraction
Kaul, P., Rathwell, S., Lam, C. S. P., Westerhout, C. M., Spertus, J. A., Anstrom, K. J., Blaustein, R. O., Ezekowitz, J. A., Pieske, B. M., Roessig, L., et al. (2023) · JACC Heart Failure · doi:10.1016/j.jchf.2022.11.015 · Cited by 15
The concurrent impact of mild cognitive impairment and frailty syndrome in heart failure
Uchmanowicz, I., Rosano, G. M. C., Piepoli, M. F., Vellone, E., Czapla, M., Lisiak, M., Diakowska, D., Prokopowicz, A., Aleksandrowicz, K., Nowak, B., et al. (2023) · Archives of Medical Science · doi:10.5114/aoms/162369 · Cited by 16
Disentangling Heart Failure and Physical Frailty
Metze, C., Iliadis, C., Körber, M. I., von Stein, J., Halbach, M., Baldus, S. E., & Pfister, R. (2023) · JACC Heart Failure · doi:10.1016/j.jchf.2023.04.011 · Cited by 15
Assessment and Management of Atrial Fibrillation in Older Adults with Frailty
Diaz, A. N. R., Troy, A. L., Kaplinskiy, V., Pritchard, A., Vani, R., Ko, D., & Orkaby, A. R. (2024) · Geriatrics · doi:10.3390/geriatrics9020050 · Cited by 15
“Briefer tools, such as 4-m gait speed or the Clinical Frailty Scale, a 9-point scale that assesses functional and health status in the 2 weeks prior, can be readily incorporated into routine clinical practice [32,33].”
BackgroundMethodLi, M., Ren, L., He, L., Lai, Y., Wang, J., Li, S., Peng, X., Zhao, M., Li, Q., Zhao, Z., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2024.03.394 · Cited by 15
Nakamaru, R., Nishimura, S., Kumamaru, H., Shoji, S., Nakatani, E., Yamamoto, H., Miyachi, Y., Miyata, H., & Kohsaka, S. (2024) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.123.010642 · Cited by 15
“28 Persistent efforts are required to develop evidence for further optimizing their integrated care.”
Cardiac Amyloidosis in Older Adults With a Focus on Frailty
Bart, N., Bianchi, G., Cuddy, S. A. M., Goyal, P., Griffin, J. M., Hummel, S. L., Macdonald, P. S., Maurer, M. S., MONTGOMERY, E. E., Nanne, M. G., et al. (2025) · JACC Advances · doi:10.1016/j.jacadv.2025.101784 · Cited by 17
Self-citationTomii, D., Lanz, J., Heg, D., Möllmann, H., Kim, W.-K., Burgdorf, C., Linke, A. H.-P., Redwood, S. R., Hilker, M., Joner, M., et al. (2025) · JACC Advances · doi:10.1016/j.jacadv.2025.101594 · Cited by 16
Invasive Management in Older Adults (≥80 Years) With Non-ST Elevation Myocardial Infarction
Fishman, B., Sharon, A., Itelman, E., Tsur, A. M., Fefer, P., Barbash, I. M., Segev, A., Matetzky, S., Guetta, V., Grossman, E., et al. (2022) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2022.03.021 · Cited by 14
Checa‐López, M., Costa‐Grille, A., Álvarez‐Bustos, A., Carnicero, J. A. C., Sinclair, A. J., Scuteri, A., Landi, F., Solano-Jaurrieta, J. J., Bellary, S., & Rodríguez‐Mañas, L. (2023) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.13374 · Cited by 14
Fountotos, R., Lauck, S., Piazza, N., Martucci, G. J., Arora, R. C., Asgar, A., Forcillo, J., Kouz, R., Labinaz, M. X., Lamy, A. L., et al. (2023) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2023.11.037 · Cited by 14
Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology – 2024
Gualandro, D. M., Fornari, L. S., Caramelli, B., Abizaid, A., Gomes, B. R., Tavares, C. A. M., Fernandes, C. J. C. D. S., Polanczyk, C. A., Jardim, C., Vieira, C. L. Z., et al. (2024) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20240590i · Cited by 14
Fumagalli, C., Ponti, L., Smorti, M., Pozza, F., Argirò, A., Zampieri, M., Mario, C. D., Marfella, R., Sardu, C., Paolisso, G., et al. (2024) · Aging Clinical and Experimental Research · doi:10.1007/s40520-024-02750-6 · Cited by 13
Frailty trajectories after a cardiovascular event among community-dwelling older people
Phyo, A. Z. Z., Tonkin, A. M., Espinoza, S. E., Vishwanath, S., Murray, A. M., Woods, R. L., Callahan, K. E., Peters, R. K., & Ryan, J. L. (2025) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf095 · Cited by 14
Left main coronary disease: evolving management concepts
Armstrong, P. W., Bates, E., & Gaudino, M. F. L. (2022) · European Heart Journal · doi:10.1093/eurheartj/ehac542 · Cited by 15
Singh, N., Faye, A. S., Abidi, M. Z., Grant, S. J., DuMontier, C., Iyer, A. S., Jain, N., Kochar, B. D., Lieber, S. B., Litke, R. R., et al. (2024) · Journal of the American Geriatrics Society · doi:10.1111/jgs.19268 · Cited by 12
Self-citationKhan, M., Nicholl, B. I., & Hanlon, P. (2025) · Ageing Research Reviews · doi:10.1016/j.arr.2025.102759 · Cited by 13
Gao, Q., Li, P., Lu, Z., Ma, M., Zhang, N., Lu, Y., & Yu, J. (2025) · BMC Public Health · doi:10.1186/s12889-025-22959-y · Cited by 12
Chehrehgosha, M., Sharifi, A., Meftah, A. M., Maleki, H., Sajjadi‐Jazi, S. M., Baharifar, H., Khoshnevisan, K., & Sharifi, F. (2024) · Maturitas · doi:10.1016/j.maturitas.2023.107905 · Cited by 12
Diretriz de Avaliação Cardiovascular Perioperatória da Sociedade Brasileira de Cardiologia – 2024
Gualandro, D. M., Fornari, L. S., Caramelli, B., Abizaid, A., Gomes, B. R., Tavares, C. A. M., Fernandes, C. J. C. D. S., Polanczyk, C. A., Jardim, C., Vieira, C. L. Z., et al. (2024) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20240590 · Cited by 29
Leso, V., Scalfi, L., Giordano, A., Reppuccia, L., Guarino, D., Fedele, M., & Iavicoli, I. (2023) · Journal of Occupational Health · doi:10.1093/joccuh/uiad006 · Cited by 11
“41,42 In the study by Berner et al, 32 a group of measures including tests of gait speed, balance, and sit-to-stand were used to assess lower extremity function,and were significantly associated with WAS.”
MethodTehrani, B. N., Sherwood, M. W., Damluji, A. A., Epps, K., Bakhshi, H., Cilia, L. A., Dassanayake, I., Eltebaney, M., Gattani, R., Howard, E. W., et al. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.031504 · Cited by 11
“2,3, 19–21 It has been proposed that the factors associated with Virchow triad are implicated in RAO (namely, endothelial injury, stasis of blood, and hypercoagulability).”
BackgroundSelf-citationFrailty and Metabolic Vulnerability in Heart Failure: A Community Cohort Study
Kumar, S., Conners, K. M., Shearer, J. J., Joo, J., Turecamo, S. E., Sampson, M. L., Wolska, A. T., Remaley, A. T., Connelly, M. A., Otvos, J. D., et al. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.031616 · Cited by 14
Pu, X., Huang, H., Zhao, X., Liu, F., Leng, Y., Deng, Y., Huang, L., Zhou, X., Xu, F., Huang, Y., et al. (2024) · Clinical Interventions in Aging · doi:10.2147/cia.s460805 · Cited by 11
“4 The occurrence of frailty in cardiac surgery patients is as high as 20% to 50% and is apparently greater than that in noncardiac surgery patients.”
Background
Metadata
- Authors
- Ijaz, N., Buta, B., Xue, Q.-L., Mohess, D. T., Bushan, A., Tran, H., Batchelor, W., deFilippi, C. R., Walston, J. D., Bandeen-Roche, K., Forman, D. E., Resar, J. R., O’Connor, C. M., Gerstenblith, G., & Damluji, A. A.
- Affiliations
- Inova Health System (US)
- Johns Hopkins University (US)
- University of Pittsburgh (US)
- Corresponding author
- Damluji, Abdulla A.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2022-02
- Volume
- 79
- Issue
- 5
- Pages
- 482-503
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC8852369
- OpenAlex
- W4210642841
- Cited by
- 412
- References
- 112
- Citations by year
- 2026: 87 · 2025: 126 · 2024: 105 · 2023: 66 · 2022: 28
- FWCI
- 11.62
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (P30AG021334)
- National Heart, Lung, and Blood Institute (K23HL153771)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- frailty, older adults, cardiovascular disease, frailty interventions, heart failure, cardiac rehabilitation, physical function, cognitive decline, physical inactivity, nutrition, social support, frailty prevention, quality of life
- MeSH terms
- Cardiac Rehabilitation, Frailty, Aged, Aging, Cardiovascular Diseases, Humans, Quality of Life, Risk Factors, Frail Elderly
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