Frailty assessment can help to provide better treatment choices for patients

A new paper from the PROCARD research group assess frailty status before and after heart treatment in patients > 80 years old. The association between levels of frailty and self-reported health outcomes is discussed, and how treatment choices for frail patients may be improved. 

Elderly woman looking out the window. Photo

Frailty is a condition with increased vulnerability due to multi-system impairments. Frailty is characterized by muscle weakness, fatigue, depression, cognitive problems, reduced grip strength and walking speed, low physical activity, malnutrition or unintentional weight loss. Frail individuals often have limitations performing activities of daily living.

The incidence of frailty increases with age, and frail older people seems to be more vulnerable to physiological stress than robust older individuals. Previous research has shown that frailty increases the risk for disease complications, side effects of medication, falls, disability and death.

The aortic heart valve carries blood to the main artery, and its narrowing (aortic stenosis) might lead to heart congestion. Symptoms of severe aortic stenosis include shortness of breath, chest pain, dizziness and loss of consciousness. Astri T Frantzen and co-authors recently published a scientific article examining changes in frailty status of patients 80> years old at baseline before surgical and catheter based treatment, and six months after the procedure. Results from this study indicate that the assessment of frailty can help guiding patients’ treatment choices. Results also support the importance of tailoring individual treatments that focus on frailty, which in turn could contribute to maintain patients' health status and quality of life.

This study shows that the assessment of frailty is especially important among patients willing to perform high risk procedures in exchange for better quality of life. As the frailest patients had the weakest starting point, they had the most to gain from treatment. 

Of 143 patients at baseline, 34% were robust, 27% pre-frail, and 39% frail. At an individual level, 65 patients changed their frailty status six months after surgery, with most of them improving their condition (40 versus 25 patients). Even though frailty was associated with lower self-reported health status, it was the frailest patients who reported the greatest improvements compared to baseline data. Findings from the study also show that frail elderly can benefit from advanced heart treatment. Therefore, clinicians should not assume that frailty necessarily lead to negative outcomes after treatment. 

Novel methods for aortic valve replacement have allowed patients 80 > years to receive advanced treatment for aortic stenosis. This has increased the clinical utility of identifying patients' frailty status. The risk of complications after surgery, as well as the risk of repeated hospital readmissions, are a financial burden for health care services. Prehabilitation, individualized care and a rehabilitation that focuses on frailty have therefore become increasingly relevant.

The mentioned article is written using data from CARDELIR, one of the patient-centered studies from the PROCARD research group.