Frailty, a syndrome characterized by an exaggerated decline in function
and reserve of multiple physiological systems, is common in older
patients with heart failure (HF) and is associated with worse clinical
and patient-reported outcomes. Although several detailed assessment
tools have been developed and validated in the geriatric population,
they are cumbersome, not validated in patients with HF, and not commonly
used in routine management of patients with HF. More recently, there
has been an increasing interest in developing simple frailty screening
tools that could efficiently and quickly identify frail patients with HF
in routine clinical settings. As the burden and recognition of frailty
in older patients with HF increase, a more comprehensive approach to
management is needed that targets deficits across multiple domains,
including physical function and medical, cognitive, and social domains.
Such a multidomain approach is critical to address the unique,
multidimensional challenges to the care of these high-risk patients and
to improve their functional status, quality of life, and long-term
clinical outcomes. This review discusses the burden of frailty, the
conceptual underpinnings of frailty in older patients with HF, and
potential strategies for the assessment, screening, and management of
frailty in this vulnerable patient population.
