Skip to main content

Advertisement

SpringerLink
Log in

Frailty and Advanced Heart Failure in Older Adults

  • Elder and Heart Disease (K. Dharmarajan, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Advances in medical therapy have resulted in a growing population of older adults with advanced heart failure. Frailty is a clinical syndrome that increases in prevalence with age and is highly prevalent in patients with heart failure. This paper reviews the complex relationship between frailty and advanced systolic heart failure in older adults, including the potential for reversal of frailty following advanced cardiac interventions.

Recent Findings

Frailty is predictive of adverse outcomes, including rehospitalization and mortality, in heart failure patients. Several small studies have shown that mechanical circulatory support can modify, and possibly reverse, functional impairments and the pathophysiologic changes associated with heart failure-related frailty.

Summary

Frailty is highly prevalent in patients with advanced heart failure and is a powerful prognostic marker. Routine frailty assessment could allow clinicians to define optimal patient-centered care strategies for older adult patients with advanced heart failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Afilalo J, Alexander KP, Mack MJ, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol. 2014;63(8):747–62. This review summarizes frailty in cardiovascular disease and provides a framework for integrating frailty assessment into clinical practice.

    Article  PubMed  Google Scholar 

  2. Fried LP, Tangen CM, Walston JD, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56A(3):M146–56. This study defined the frailty phenotype and is the most extensively validated and frequently cited frailty assessment tool.

    Article  Google Scholar 

  3. Afilalo J, Karunananthan S, Eisenberg MJ, Alexander KP, Bergman H. Role of frailty in patients with cardiovascular disease. Am J Cardiol. 2009;103(11):1616–21.

    Article  PubMed  Google Scholar 

  4. Goldfarb M, Sheppard R, Afilalo J. Prognostic and therapeutic implications of frailty in older adults with heart failure. Curr Cardiol Rep. 2015;17(11):92.

    Article  PubMed  Google Scholar 

  5. Dobbels F, Mauthner O, Milisen K. Frailty in left ventricular assist device destination therapy: putting a new motor in a rickety old car running out of gas? J Heart Lung Transplant. 2014;33(4):347–9.

    Article  PubMed  Google Scholar 

  6. Finn M, Green P. The application of frailty to the modern cardiac risk assessment: a case-based review. Curr Cardiovasc Risk Rep. 2015;9(12).

  7. Goldwater DS, Pinney SP. Frailty in advanced heart failure: a consequence of aging or a separate entity? Clin Med Insights Cardiol. 2015;9 Suppl 2:39–46.

    PubMed  PubMed Central  Google Scholar 

  8. McAdams-DeMarco MA, Law A, Salter ML, et al. Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis. J Am Geriatr Soc. 2013;61(6):896–901.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Park SK, Richardson CR, Holleman RG, Larson JL. Frailty in people with COPD, using the national health and nutrition evaluation survey dataset (2003–2006). Heart Lung. 2013;42(3):163–70.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pel-Littel RE, Schuurmans MJ, Emmelot-Vonk MH, Verhaar HJ. Frailty: defining and measuring of a concept. J Nutr Health Aging. 2009;13(4):390–4.

    Article  CAS  PubMed  Google Scholar 

  11. Forman DE, Alexander KP. Frailty: a vital sign for older adults with cardiovascular disease. Can J Cardiol. 2016;32(9):1082–7.

    Article  PubMed  Google Scholar 

  12. Vidan MT, Blaya-Novakova V, Sanchez E, Ortiz J, Serra-Rexach JA, Bueno H. Prevalence and prognostic impact of frailty and its components in non-dependent elderly patients with heart failure. Eur J Heart Fail. 2016;18(7):869–75.

    Article  CAS  PubMed  Google Scholar 

  13. Boxer RS, Shah KB, Kenny AM. Frailty and prognosis in advanced heart failure. Curr Opin Support Palliat Care. 2014;8(1):25–9.

    Article  PubMed  Google Scholar 

  14. Dunlay SM, Park SJ, Joyce LD, et al. Frailty and outcomes after implantation of left ventricular assist device as destination therapy. J Heart Lung Transplant. 2014;33(4):359–65. This study found that presence of frailty pre-LVAD implantation was associated with increased risk of death.

    Article  PubMed  Google Scholar 

  15. Cacciatore F, Abete P, Mazzella F, et al. Frailty predicts long-term mortality in elderly subjects with chronic heart failure. Eur J Clin Investig. 2005;35(12):723–30.

    Article  CAS  Google Scholar 

  16. Mozaffarian D BE, Go AS, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015.

  17. Goodlin SJ. Function, failure, and frailty. J Card Fail. 2010;16(5):396–7.

    Article  PubMed  Google Scholar 

  18. Palau P, Nunez E, Dominguez E, Sanchis J, Nunez J. Physical therapy in heart failure with preserved ejection fraction: a systematic review. Eur J Prev Cardiol. 2016;23(1):4–13.

    Article  PubMed  Google Scholar 

  19. van Riet EE, Hoes AW, Wagenaar KP, Limburg A, Landman MA, Rutten FH. Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. Eur J Heart Fail. 2016;18(3):242–52.

    Article  PubMed  Google Scholar 

  20. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355(3):251–9.

    Article  CAS  PubMed  Google Scholar 

  21. Martinez-Selles M, Vidan MT, Lopez-Palop R, et al. End-stage heart disease in the elderly. Rev Esp Cardiol. 2009;62(4):409–21.

    Article  PubMed  Google Scholar 

  22. Fang JC, Ewald GA, Allen LA, et al. Advanced (stage D) heart failure: a statement from the Heart Failure Society of America Guidelines Committee. J Card Fail. 2015;21(6):519–34.

    Article  PubMed  Google Scholar 

  23. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239.

    Article  PubMed  Google Scholar 

  24. Steinberg BA, Zhao X, Heidenreich PA, et al. Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation. 2012;126(1):65–75.

    Article  PubMed  Google Scholar 

  25. Martin-Sanchez FJ, Rodriguez-Adrada E, Mueller C, Vidan MT, Christ M, Peacock WF, et al. The effect of frailty on 30-day mortality risk in older patients with acute heart failure attended in the Emergency Department. Acad Emerg Med. 2016.

  26. Flint KM, Matlock DD, Lindenfeld J, Allen LA. Frailty and the selection of patients for destination therapy left ventricular assist device. Circ Heart Fail. 2012;5(2):286–93. This article proposes the concept of LVAD-responsive, or reversible, frailty.

    Article  PubMed  Google Scholar 

  27. Joyce E. Frailty in advanced heart failure. Heart Fail Clin. 2016;12(3):363–74.

    Article  PubMed  Google Scholar 

  28. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing. 2010;39(4):412–23.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Afilalo J. Frailty in patients with cardiovascular disease: why, when, and how to measure. Curr Cardiovasc Risk Rep. 2011;5(5):467–72.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sullivan MJ, Green HJ, Cobb FR. Skeletal muscle biochemistry and histology in ambulatory patients with long-term heart failure. Circulation. 1990;81(2):518–27.

    Article  CAS  PubMed  Google Scholar 

  31. Khan H, Kalogeropoulos AP, Georgiopoulou VV, et al. Frailty and risk for heart failure in older adults: the health, aging, and body composition study. Am Heart J. 2013;166(5):887–94.

    Article  PubMed  Google Scholar 

  32. de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10(1):104–14.

    Article  PubMed  Google Scholar 

  33. Jermyn R, Patel S. The biologic syndrome of frailty in heart failure. Clin Med Insights Cardiol. 2014;8 Suppl 1:87–92.

    PubMed  Google Scholar 

  34. Martin-Sanchez FJ, Christ M, Miro O, et al. Practical approach on frail older patients attended for acute heart failure. Int J Cardiol. 2016;222:62–71.

    Article  PubMed  Google Scholar 

  35. Robinson TN, Wallace JI, Wu DS, et al. Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient. J Am Coll Surg. 2011;213(1):37–42. discussion −4.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Chung CJ, Wu C, Jones M, et al. Reduced handgrip strength as a marker of frailty predicts clinical outcomes in patients with heart failure undergoing ventricular assist device placement. J Card Fail. 2014;20(5):310–5. This study found that impaired handgrip strength was associated with higher postoperative complication rates and increased mortality after LVAD implantation, and that handgrip strength increased post-LVAD implantation in a subgroup of patients.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94.

    Article  CAS  PubMed  Google Scholar 

  39. Boxer R, Kleppinger A, Ahmad A, Annis K, Hager D, Kenny A. The 6-minute walk is associated with frailty and predicts mortality in older adults with heart failure. Congest Heart Fail. 2010;16(5):208–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Lee DH, Buth KJ, Martin BJ, Yip AM, Hirsch GM. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation. 2010;121(8):973–8.

    Article  PubMed  Google Scholar 

  41. Afilalo J, Eisenberg MJ, Morin JF, et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol. 2010;56(20):1668–76.

    Article  PubMed  Google Scholar 

  42. Rogers JG, Bostic RR, Tong KB, Adamson R, Russo M, Slaughter MS. Cost-effectiveness analysis of continuous-flow left ventricular assist devices as destination therapy. Circ Heart Fail. 2012;5(1):10–6.

    Article  PubMed  Google Scholar 

  43. Fülster S, Tacke M, Sandek A, et al. Muscle wasting in patients with chronic heart failure: results from the studies investigating co-morbidities aggravating heart failure (SICA-HF). Eur Heart J. 2013;34(7):512–9.

  44. Haykowsky MJ, Timmons MP, Kruger C, McNeely M, Taylor DA, Clark AM. Meta-analysis of aerobic interval training on exercise capacity and systolic function in patients with heart failure and reduced ejection fraction. Am J Cardiol. 2013;111(10):1466–9.

  45. Anker SD, Ponikowski P, Varney S, et al. Wasting as independent risk factor for mortality in chronic heart failure. Lancet. 1997;349(9058):1050–3.

  46. Butts B, Gary R. Coexisting frailty, cognitive impairment, and heart failure: implications for clinical care. J Clin Outcomes Manag. 2015;22(1):38–46.

    PubMed  PubMed Central  Google Scholar 

  47. Madan SA, Fida N, Barman P, et al. Frailty assessment in advanced heart failure. J Card Fail. 2016;22(10):840–4.

    Article  PubMed  Google Scholar 

  48. Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901–8.

    Article  PubMed  Google Scholar 

  49. Dominguez-Rodriguez A, Abreu-Gonzalez P, Jimenez-Sosa A, et al. The impact of frailty in older patients with non-ischaemic cardiomyopathy after implantation of cardiac resynchronization therapy defibrillator. Europace. 2015;17(4):598–602.

    Article  PubMed  Google Scholar 

  50. Kirklin JK, Naftel DC, Pagani FD, et al. Sixth INTERMACS annual report: a 10,000-patient database. J Heart Lung Transplant. 2014;33(6):555–64.

  51. Atluri P, Goldstone AB, Kobrin DM, et al. Ventricular assist device implant in the elderly is associated with increased, but respectable risk: a multi-institutional study. Ann Thorac Surg. 2013;96(1):141–7.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435–43.

    Article  CAS  PubMed  Google Scholar 

  53. Pocock SJ, Ariti CA, McMurray JJ, et al. Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J. 2013;34(19):1404–13.

    Article  PubMed  Google Scholar 

  54. Adamson RM, Stahovich M, Chillcott S, et al. Clinical strategies and outcomes in advanced heart failure patients older than 70 years of age receiving the HeartMate II left ventricular assist device: a community hospital experience. J Am Coll Cardiol. 2011;57(25):2487–95.

    Article  PubMed  Google Scholar 

  55. Butler CR, Jugdutt BI. Mechanical circulatory support for elderly heart failure patients. Heart Fail Rev. 2012;17(4–5):663–9.

    Article  PubMed  Google Scholar 

  56. Huang R, Deng M, Rogers JG, et al. Effect of age on outcomes after left ventricular assist device placement. Transplant Proc. 2006;38(5):1496–8.

    Article  CAS  PubMed  Google Scholar 

  57. Kwon MH, Moriguchi JD, Ardehali A, et al. Use of ventricular assist device as a bridge to cardiac transplantation: impact of age and other determinants on outcomes. Tex Heart Inst J. 2009;36(3):214–9.

    PubMed  PubMed Central  Google Scholar 

  58. Investigators LS, Pahor M, Blair SN, et al. Effects of a physical activity intervention on measures of physical performance: results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci. 2006;61(11):1157–65.

    Article  Google Scholar 

  59. Cameron ID, Fairhall N, Langron C, et al. A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial. BMC Med. 2013;11:65.

    Article  PubMed  PubMed Central  Google Scholar 

  60. O’Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301(14):1439–50.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Flynn KE, Pina IL, Whellan DJ, et al. Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301(14):1451–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Abshire M, Dennison Himmelfarb CR, Russell SD. Functional status in left ventricular assist device-supported patients: a literature review. J Card Fail. 2014;20(12):973–83.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Lund LH, Freda P, Williams JJ, LaManca JJ, LeJemtel TH, Mancini DM. Growth hormone resistance in severe heart failure resolves after cardiac transplantation. Eur J Heart Fail. 2009;11(5):525–8.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Khawaja T, Chokshi A, Ji R, et al. Ventricular assist device implantation improves skeletal muscle function, oxidative capacity, and growth hormone/insulin-like growth factor-1 axis signaling in patients with advanced heart failure. J Cachex Sarcopenia Muscle. 2014;5(4):297–305.

    Article  Google Scholar 

  65. Emani S, Brewer RJ, John R, et al. Patients with low compared with high body mass index gain more weight after implantation of a continuous-flow left ventricular assist device. J Heart Lung Transplant. 2013;32(1):31–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, New York University School of Medicine, New York University Langone Medical Center, 550 First Avenue, NBV 16N30, New York, NY, 10016, USA

    Jennifer R. Riggs

  2. Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York University Langone Medical Center, New York, NY, USA

    Alex Reyentovich & John A. Dodson

  3. Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA

    Mathew S. Maurer

  4. Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine, New York University Langone Medical Center, New York, NY, USA

    John A. Dodson

Authors
  1. Jennifer R. Riggs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alex Reyentovich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mathew S. Maurer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John A. Dodson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer R. Riggs.

Ethics declarations

Funding

Dr. Dodson receives support from a Patient Oriented Career Development Award (K23 AG052463) from the National Institutes of Health/National Institute of Aging and a Mentored Clinical and Population Research Award from the American Heart Association.

Dr. Maurer receives support from a Midcareer Mentoring Award in Geriatric Cardiology (K24 AG036778) from the National Institutes of Health/National Institute of Aging.

Dr. Maurer and Dr. Reyentovich receive support from an exploratory grant (R21 AG046703) from the National Institutes of Health.

Conflict of Interest

Drs Riggs, Reyentovich, and Maurer have no conflicts of interest

Dr. Dodson serves as a Consultant for Novartis Pharmaceuticals on a research project unrelated to the current study.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Elder and Heart Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Riggs, J.R., Reyentovich, A., Maurer, M.S. et al. Frailty and Advanced Heart Failure in Older Adults. Curr Cardiovasc Risk Rep 11, 14 (2017). https://doi.org/10.1007/s12170-017-0539-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s12170-017-0539-4

Keywords

Search

Navigation