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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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Self-citationHow Would You Manage This Patient With Heart Failure With Preserved Ejection Fraction?
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“2 This is despite data supporting periprocedural rehabilitation and nutritional measures among frail patients.”
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Addressing Frailty in Cardiology
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“15,16 In an effort to address the question of optimal frailty assessment we used the Million Veteran Program (MVP), a large, well-phenotyped cohort of over 900 000 US veterans.”
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“Additionally, Ijaz et al. (2022) [21] described a bidirectional relationship between CVD and frailty, in which shared pathophysiological mechanisms such as cellular dysfunction, chronic inflammation, and impaired vascular function promote the development and progression of both conditions.”
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Risk of Cardiovascular Disease Death in Older Malignant Melanoma Patients: A Population-Based Study
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“CVD deaths, which most frequently appear in the elderly, should focus attention on causespecific mortality at older ages with implications for prevention strategies [8].”
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“Studies have consistently shown that frailty is associated with an elevated risk of various chronic conditions, 37 including coronary artery disease, myocardial infarction, heart failure, 38 stroke, and type 2 diabetes.”
A non-randomized pilot study to test the feasibility of developing a frailty scale for pet cats
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“Problem-solving and reasoning tasks are also suggested as an intervention for the cognitive domain of frailty in humans (40).”
Chronic Coronary Syndrome in Frail Old Population
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“Studies have shown clear interactions between frailty status and the complications of coronary heart disease [2,8,9].”
BackgroundMethodComparing Virtual and Center-Based Cardiac Rehabilitation on Changes in Frailty
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“Frailty describes the degree to which people accumulate these health problems with age, which results from decreased physiological reserve across multiple physiological systems that increases vulnerability to worsening health [4].”
BackgroundHydrogen Sulfide Ameliorates Heart Aging by Downregulating Matrix Metalloproteinase-9
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Neuroprotective strategies for cognitive decline in type 2 diabetes
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The pattern of the frailty syndrome in chronic heart failure
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“39”
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“Such multimodal programs would include the prescription of individualized multicomponent exercise before and after AVR [47, 48].”
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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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