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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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The application value of frailty assessment tools in the perioperative period: A narrative review
Shen, H., Ju, M., Wu, X., Shi, S., Sun, J., & Tian, M. (2026) · Journal of Anesthesia and Translational Medicine · doi:10.1016/j.jatmed.2026.04.002
“58 These factors interact to promote PND. 59,60 Thus, the FFP may serve as an indicator for PND risk, based on the shared pathophysiological link between frailty and reduced brain functional reserve.”
Gong, X., Liu, S., Shen, L., Li, Y. X., Xie, W., Cai, Y., Chen, Q., Li, X., Liu, Z. H., Wang, C., et al. (2026) · Maturitas · doi:10.1016/j.maturitas.2026.109006
Frailty Syndrome and Depressive Symptoms in Patients with Ischemic Heart Disease
Евгеньевна, К. К., Tsygankova, D. P., Neeshpapa, A., Bazdyrev, E. D., Каретникова, В. Н., & Барбараш, О. Л. (2026) · Diagnostics · doi:10.3390/diagnostics16111707
Menoud, G., Mgbaman, F., Santos, G. C., Cavin-Trombert, A., Mabire, C., & Schäfer‐Keller, P. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-111747 · Cited by 1
Physical Frailty, Self-Care Behaviors, and 6-Month Clinical Outcomes Among Adults With Heart Failure
Denfeld, Q. E., Hiatt, S. O., Dieckmann, N. F., Hansen, L., Rosenkranz, S. E., Camacho, S. A., Chien, C., Riegel, B. J., & Lee, C. S. (2026) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000001342
Coutinho, M. L., Delgado, L. M., Torres, I. O., Rocha-Neves, J. P., Zerati, A. E., D’Oria, M., & Leao, P. P. (2026) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2026.06.034
Chen, L., Zheng, W., & Liu, L. (2026) · Medicine · doi:10.1097/md.0000000000049742
“[33,34] Furthermore, rapid CKM progression may reflect, rather than directly demonstrate, biological processes such as a heightened inflammatory burden or mitochondrial dysfunction, which have been proposed as shared pathological pathways underlying both cardiovascular aging and physical frailty.”
Ding, Y., He, D., He, J., Wu, J., Shen, Z., Chen, S., Zhou, D., Yuan, C., Zhu, Y., & Huang, H. (2026) · Journal of the American Heart Association · doi:10.1161/jaha.125.050557
Kendall, B., Dykstra, B. J., Anderson, Q. T., Breuer, R., van Bergen, S., & Hayes, E. (2026) · Journal of Aging and Physical Activity · doi:10.1123/japa.2025-0257
Potere, N., Xu, Y., Mallick, R., Wang, T., Hill, D., Lazo‐Langner, A., Tagalakis, V., Shivakumar, S., Nisio, M. D., Wells, P. S., et al. (2026) · Cardio-Oncology · doi:10.1186/s40959-026-00542-7
“Integrating ECOG-PS with dedicated frailty measures is recommended in onco-geriatric care and may refine prognostication and clinical decision-making in cancer-associated VTE [37, 39].”
Wu, J.-C., Weng, T., & Xu, Q. (2026) · Archives of Public Health · doi:10.1186/s13690-026-01970-8
“Given the potential reversibility of frailty, targeted interventions—nutritional [41], physical [42], pharmacological [43], or behavioral [43]—could meaningfully alter health trajectories.”
Zhao, S., Wang, Z., & Chang, L. (2026) · BMC Cardiovascular Disorders · doi:10.1186/s12872-026-06356-w
“Emerging evidence suggests that higher FI and accelerated frailty progression are associated with increased CMM risk [17] and frailty is also more prevalent among individuals with cardiovascular disease, diabetes, and stroke [18–20].”
Albişteanu, S.-M., Nistoreanu-Neculau, B., Nistoreanu‐Neculau, A., Ștefăniu, R., Grigoraș, G., Lungu, I.-D., Constantinescu, D.-G., Turcu, A.-M., Ilie, A. C., & Pîslaru, A. I. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15156083
“This finding is consistent with recent evidence emphasizing that frailty and functional status are major determinants of cardiovascular prognosis in older adults, sometimes surpassing the predictive value of classical cardiological parameters [13].”
Alexander, K. P., Damluji, A. A., Erqou, S., Ferrucci, L., Forman, D. E., Galasko, D., & Yaffe, K. S. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2026.07.009 · Cited by 4
Self-citationTimurtaş, M. E., & Inceer, M. (2026) · Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi · doi:10.46413/boneyusbad.1767098
Li, J., Liu, M., & Wang, J. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1893715
Passo, B. D., Tonet, E., Raisi, A., Zagnoni, S., Chiaranda, G., Pasanisi, G., Pavasini, R., Cimaglia, P., Piva, T., Casella, G., et al. (2026) · Circulation Population Health and Outcomes · doi:10.1161/circoutcomes.126.013410
Cardiac Rehabilitation and Frailty: A Rescue Rope for a Slippery Slope?
Thomas, R. J. (2026) · Circulation Population Health and Outcomes · doi:10.1161/circoutcomes.126.014093
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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