Frailty in elderly patients with acute myocardial infarction

Kamilya Kedelbaeva 1 * , Salim Berkinbaev 1, Gulnar Dzhunusbekova 1, Meyramgul Tundybaeva 1, Aliya Kabdulkayeva 1
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1 Department of Cardiology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 19, Issue 1, pp. 7-15. https://doi.org/10.23950/jcmk/11586
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ABSTRACT

        In recent years, there has been increasing interest in the frailty as a prognostic factor of acute myocardial infarction in elderly patients. Frailty is an important prognostic marker of frequent complications, readmission to hospital, high hospital mortality and major cardiovascular events in elderly patients with acute myocardial infarction. This category of persons is often not allowed to undergo invasive interventions and are often excluded from the recommended treatment, and they tolerate cardiac surgery worse, recovery from illness is slower, functionality decreases, then disability and death develop.
      The present review aims to investigate the impact of frailty on management of elderly patients with acute myocardial infarction (AMI).
    To analyze the literature, we searched for information on this issue in PubMed / MEDLINE, PMC, Web of Science, Scopus, The Сocrane Library. The search depth was 15 years: from 2006 to 2021.
      One of the important factors in improving clinical outcomes, improving the quality of life in elderly patients with acute myocardial infarction is the early detection of frailty. Frailty assessment is a valuable tool for risk stratification that can be helpful to clinicians in deciding the optimal pathway for management and treatment strategies. Risk prediction is also important for deciding secondary prevention and cardiac rehabilitation measures in the elderly with acute myocardial infarction.

CITATION

Kedelbaeva K, Berkinbaev S, Dzhunusbekova G, Tundybaeva M, Kabdulkayeva A. Frailty in elderly patients with acute myocardial infarction. J CLIN MED KAZ. 2022;19(1):7-15. https://doi.org/10.23950/jcmk/11586

REFERENCES

  • Wan H., Goodkind D., Kowal P. International Population Reports: An Aging World: 2015. DC: U.S. Government Publishing Office. 2016; 165. https://doi.org/10.13140/RG.2.1.1088.9362
  • Hospers GP, Smulders YM, Maier AB, Deeg DJ, Muller M. Relation between blood pressure and mortality risk in an older population: role of chronological and biological age. Journal of Internal Medicine. 2015;277(4):488-497. https://doi.org/10.1111/joim.12284
  • Oganov R.G., Simanenkov V.I., Bakulin I.G., Bakulina N.V., Barbarash O.L. i dr. Soputstvuyushchie zabolevaniya v klinicheskoi praktike. Algoritmy diagnostiki i lecheniya Vserossiiskii fond «Assotsiatsiya vrachei obshchei praktiki (semeinykh vrachei) Rossiiskoi Federatsii», Natsional'naya meditsinskaya assotsiatsiya po izucheniyu mul'timorbidnosti, Fond «PROFMEDFORUM» (Concomitant diseases in clinical practice. Diagnostic and treatment algorithms All-Russian Foundation "Association of General Practitioners (Family Physicians) of the Russian Federation", National Medical Association for the Study of Multimorbidity, Foundation "PROFMEDFORUM") [in Russian]. Kardiovaskulyarnaya terapiya i profilaktika. 2019; 18 (1): 5–66 https://doi.org/10.15829/1728-8800-2019-1-5-66
  • Bebb O, Smith FG, Clegg A, et al. Frailty and acute coronary syndrome: a structured literature review. Eur Heart J Acute Cardiovasc Care. 2018; 7: 166–175, doi: 10.1177/2048872617700873
  • Shamliyan T., Talley K.M.C., Ramakrishnan R. and Kane R.L: "Association of frailty with survival: a systematic literature review". Ageing Res Rev. 2013; 12(2):719-36. https://doi.org/10.1016/j.arr.2012.03.001
  • Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392-397. https://doi.org/10.1016/j.jamda.2013.03.022
  • Turner G. Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing. 2014;43(6):744-7. https://doi.org/10.1093/ageing/afu138
  • Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752-62. https://doi.org/10.1016/S0140-6736(12)62167-9
  • McGowan PO, Szyf M. Environmental epigenomics: understanding the effects of parental care on the epigenome. Essays Biochem. 2010;48(1):275–87. https://doi.org/10.1042/bse0480275
  • Yao X, Li H, Leng SX. Inflammation and immune system alterations in frailty. Clin Geriatr Med. 2011;27(1):79-87. https://doi.org/10.1016/j.cger.2010.08.002
  • Varricchi G, Bencivenga L, Poto R, Pecoraro A, Shamji MH, Rengo G. The emerging role of T follicular helper (TFH) cells in aging: Influence on the immune frailty. Ageing Res Rev. 2020;61:101071. https://doi.org/10.1016/j.arr.2020.101071
  • Jin K. New perspectives on healthy aging. Prog. Neurobiol. 2017;157:1. https://doi.org/10.1016/j.pneurobio.2017.08.006
  • Cesari M., Araujo de Carvalho I., Amuthavalli Thiyagarajan J., Cooper C., Martin F.C., Reginster J.Y., Vellas B., Beard J.R. Evidence for the Domains Supporting the Construct of Intrinsic Capacity. J. Gerontol. A Biol. Sci. Med. Sci. 2018;73:1653–1660. https://doi.org/10.1093/gerona/gly011
  • Deutz N.E., Bauer J.M., Barazzoni R., Biolo G., Boirie Y., Bosy-Westphal A., Cederholm T., Cruz-Jentoft A., Krznariç Z., Nair K.S., et al. Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group. Clin. Nutr. 2014;33:929–936. https://doi.org/10.1016/j.clnu.2014.04.007
  • Kelaiditi E, Guyonnet S, Cesari M. Is nutrition important to postpone frailty? Curr Opin Clin Nutr Metab Care. 2015;18(1):37-42. https://doi.org/10.1097/MCO.0000000000000129
  • Bouillon R, Marcocci C, Carmeliet G, Bikle D, White JH, Dawson-Hughes B, Lips P, Munns CF, Lazaretti-Castro M, Giustina A, Bilezikian J. Skeletal and Extraskeletal Actions of Vitamin D: Current Evidence and Outstanding Questions. Endocr Rev. 2019;40(4):1109-1151. https://doi.org/10.1210/er.2018-00126
  • Bruyere O, Cavalier E, Buckinx F, Reginster JY. Relevance of vitamin D in the pathogenesis and therapy of frailty. Current Opinion in Clinical Nutrition. 2017;20(1):26-29. https://doi.org/10.1097/mco.0000000000000334
  • Vogt S, Zierer A, Laxy M, Koenig W, Linkohr B, Lin-seisen J, Thorand B. Association of serum vitamin D with change in weight and total body fat in a German cohort of older adults. European Journal of Clinical Nutrition. 2016;70(1):136-139. https://doi.org/10.1038/ejcn.2015.89
  • Gutierrez-Valencia M, Izquierdo M, Cesari M, Ca-sas-Herrero A. The relationship between frailty and polyphar-macy in older people: A systematic review. British Journal of Clinical Pharmacology.2018;84(7):1432–1444. https://doi.org/10.1111/ bcp.13590
  • Palmer K, Villani ER, Vetrano DL, Cherubini A, Cruz-Jentoft AJ, Curtin D, et al. Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis. European Geriatric Medicine. 2019;10(1):9–36. https://doi.org/10.1007/s41999-018-0124-5
  • Herr M, Robine JM, Pinot J, Arvieu JJ, Ankri J. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiology and Drug Safety. 2015; 24:637-646. https://doi.org/1002/pds.3772
  • Stenholm S, Ferrucci L, Vahtera J, Hoogendijk EO, Huisman M, Pentti J, et al. Natural Course of Frailty Components in People Who Develop Frailty Syndrome: Evidence From Two Cohort Studies. J Gerontol A Biol Sci Med Sci. 2019;74(5):667–674. https://doi.org/10.1093/gerona/gly132
  • Tkacheva O.N, Kotovskaya Yu.E., Ostapenko V.S., Sharashkina N.V. Senile asthenia: What you need to know about her first level physician [in Russian]. Russian Medical Journal. 2017; 25: 1820–1822.
  • Kojima G. Prevalence of frailty in nursing homes: A systematic review and metaanalysis. J. Am. Med. Dir. Assoc. 2016; 16: 940–945. https://doi.org/10.1519/JPT.0000000000000097
  • Siriwardhana DD, Hardoon S, Rait G, Weerasinghe MC, Walters KR. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open. 2018;8(3):e018195. https://doi.org/10.1136/bmjopen-2017-018195
  • Kojima G, Iliffe S, Taniguchi Y, et al. . Prevalence of frailty in Japan: a systematic review and meta-analysis. J Epidemiol 2017;27. https://doi.org/10.1016/j.je.2016.09.008
  • Vaingankar JA, Chong SA, Abdin E, et al. Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults. Geriatr Gerontol Int 2016;12. https://doi.org/10.1111/ggi.12891
  • Chen L-J, Chen C-Y, Lue B-H, et al. . Prevalence and Associated Factors of Frailty Among Elderly People in Taiwan. Int J Gerontol 2014;8:114–9. https://doi.org/10.1016/j.ijge.2013.12.002
  • Setiati S, Soejono CH, Harimurti K, Dwimartutie N, Aryana IGPS, Sunarti S, et al. Frailty and Its Associated Risk Factors: First Phase Analysis of Multicentre Indonesia Longitudinal Aging Study. Front Med (Lausanne). 2021;8:658580. https://doi.org/10.3389/fmed.2021.658580
  • Shinkai S, Yoshida H, Taniguchi Y, Murayama H, Nishi M, Amano H et al. Public health approach to preventing frailty in the community and its effect on healthy aging in Japan. Geriatr Gerontol Int. 2016;16 Suppl 1:87-97. https://doi.org/10.1111/ggi.12726
  • Hoogendijk EO, Rockwood K, Theou O, Armstrong JJ, Onwuteaka-Philipsen BD, Deeg DJH, et al. Tracking changes in frailty throughout later life: results from a 17-year longitudinal study in the Netherlands. Age Ageing. 2018;47(5):727–33. https://doi.org/10.1093/ageing/afy081
  • He B, Ma Y, Wang C, Jiang M, Geng C, Chang X, et al. Prevalence and Risk Factors for Frailty Among Community-Dwelling Older People in China: A Systematic Review and Meta-Analysis. J Nutr, Health & Aging. 2019;23(5):442-450. https://doi.org/10.1007/s12603-019-1179-9
  • Tkacheva O.N., Runikhina N.K., Ostapenko V.S., Sharashkina N.V., Mkhitaryan E.A., Onuchina Yu.S., Lysenkov S.N. Validatsiya oprosnika dlya skrininga sindroma starcheskoi astenii v ambulatornoi praktike (Validation of a questionnaire for screening senile asthenia syndrome in outpatient practice) [in Russian]. Uspekhi gerontologii 2017; 30, 2, 236–242.
  • Onder G., Rezza G., Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. 2020;323:1775–1776. https://doi.org/10.1001/jama.2020.4683
  • Docherty A.B., Harrison E.M., Green C.A., Hardwick H.E., Pius R., Norman L., Holden K., et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: Prospective observational cohort study. BMJ. 2020;369 https://doi.org/10.1136/bmj.m1985
  • Chakrabarty B, Das D, Bulusu G, Roy A. Network-Based Analysis of Fatal Comorbidities of COVID-19 and Potential Therapeutics. IEEE/ACM Trans Comput Biol Bioinform. 2021;18(4):1271-1280. https://doi.org/10.1109/TCBB.2021.3075299
  • Johns Hopkins University. (2021. COVID-19. Available online at: https://coronavirus.jhu.edu/map.html (2021).
  • Maltese G, Corsonello A, Di Rosa M, Soraci L, Vitale C, Corica F, et al. . Frailty and COVID-19: a systematic scoping review. J Clin Med. 2020; 9:2106. https://doi.org/10.3390/jcm9072106
  • Jonathan Hewitt, Ben Carter, Arturo Vilches-Moraga, Terence J Quinn, Philip Braude, Alessia Verduri et al, The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study. Lancet Public Health 2020; 5: e444–51 Published Online June 30, 2020. https://doi.org/10.1016/S2468-2667(20)30146-8
  • Pranata R, Henrina J, Lim MA, Lawrensia S, Yonas E, Vania R, et al. Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis. Arch Gerontol Geriatr. 2021;93:104324. https://doi.org/10.1016/j.archger.2020.104324
  • Andrés-Esteban EM, Quintana-Diaz M, Ramírez-Cervantes KL, Benayas-Peña I, Silva-Obregón A, Magallón-Botaya R, et al. Outcomes of hospitalized patients with COVID-19 according to level of frailty. PeerJ. 2021;9:e11260. https://doi.org/10.7717/peerj.11260
  • Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690. https://doi.org/10.1001/jamaneurol.2020.1127
  • O'Hanlon S, Inouye SK. Delirium: a missing piece in the COVID-19 pandemic puzzle. Age Ageing. 2020;49(4):497-498. https://doi.org/10.1093/ageing/afaa094
  • Mcloughlin BC, Miles A, Webb TE, Knopp P, Eyres C, Fabbri A, et al. Functional and cognitive outcomes after COVID-19 delirium. Eur Geriatr Med. 2020;11(5):857-862. https://doi.org/10.1007/s41999-020-00353-8
  • Zhavoronkov A. Geroprotective and senoremediative strategies to reduce the comorbidity, infection rates, severity, and lethality in gerophilic and gerolavic infections. Aging (Albany NY). 2020;12(8):6492-6510. https://doi.org/10.18632/aging.102988
  • Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, et.al Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging. 2019;23(9):771-787. https://doi.org/10.1007/s12603-019-1273-z
  • Antonsen L, Jensen LO, Terkelsen CJ, et al. Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST-segment elevation myocardial infarction: from the Western Denmark Heart Registry. Catheter Cardiovasc Interv 2013;81:912–9. https://doi.org/10.1002/ccd.24591
  • Rowland B, Kunadian V. Challenges in the management of older patients with acute coronary syndromes in the COVID-19 pandemic. Heart. 2020;106:1296–301. https://doi.org/10.1136/heartjnl-2020-317011
  • Murali-Krishnan R, Iqbal J, Rowe R, Hatem E, Parviz Y, Richardson J, Sultan A, Gunn J. Impact of frailty on outcomes after percutaneous coronary intervention: a prospective cohort study. Open Heart. 2015;2(1):e000294. https://doi.org/10.1136/openhrt-2015-000294
  • Alonso Salinas GL, Sanmartı´n Ferna´ndez M, Pascual Izco M, et al. Frailty is a short-term prognostic marker in acute coronary syndrome of elderly patients. Eur Heart J Acute Cardiovasc Care. 2016;5:434–440. https://doi.org/10.1177/2048872616644909
  • Sanchis J, Ruiz V, Bonanad C, et al. Prognostic value of geriatric conditions beyond age after acute coronary syndrome. Mayo Clin Proc. 2017;92:934–939. https://doi.org/10.1016/j.mayocp.2017.01.018
  • Putthapiban P, Vutthikraivit W, Rattanawong P, Sukhumthammarat W, Kanjanahattakij N, Kewcharoen J, Amanullah A. Association of frailty with all-cause mortality and bleeding among elderly patients with acute myocardial infarction: a systematic review and meta-analysis. J Geriatr Cardiol. 2020;17(5):270-278. https://doi.org/10.11909/j.issn.1671-5411.2020.05.006
  • Uchmanowicz I, Lisiak M, Wleklik M, Gurowiec P, Kałużna-Oleksy M. The relationship between frailty syndrome and quality of life in older patients following acute coronary syndrome. Clin Interv Aging. 2019;14:805-816. https://doi.org/10.2147/CIA.S204121
  • White HD, Westerhout CM, Alexander KP, Roe MT, Winters KJ, Cyr DD, et al. TRILOGY ACS investigators. Frailty is associated with worse outcomes in non-ST-segment elevation acute coronary syndromes: Insights from the Targeted platelet Inhibition to clarify the Optimal strategy to medically manage Acute Coronary Syndromes (TRILOGY ACS) trial. Eur Heart J Acute Cardiovasc Care. 2016;5(3):231-42. https://doi.org/10.1177/2048872615581502
  • Patel A, Goodman S.G, Yan A.T, Alexander K.P, Wong C.L, Cheema A.N, et al. Frailty and Outcomes After Myocardial Infarction: Insights from the CONCORDANCE Registry. J. Am. Heart Assoc. 2018;7(18):e009859. https://doi.org/10.1161/JAHA.118.009859
  • Dou Q, Wang W, Wang H et al. Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis. BMC Geriatr. 2019;19:222. https://doi.org/10.1186/s12877-019-1242-8
  • Kang L, Zhang S-Y, Zhu W-L, et al. Is frailty associated with short-term outcomes for elderly patients with acute coronary syndrome? J Geriatr Cardiol JGC. 2015;12(6):662–667. https://doi.org/10.11909/j.issn.1671-5411.2015.06.010
  • Freeman AM, Morris PB, Barnard N, et al. Trending cardiovascular nutrition controversies. J Am Coll Cardiol. 2017;69(9):1172–1187. https://doi.org/10.1016/j.jacc.2016.10.086
  • Chen L, Huang Z, Lu J, Yang Y, Pan Y, Bao K, et al. Impact of the Malnutrition on Mortality in Elderly Patients Undergoing Percutaneous Coronary Intervention. Clin Interv Aging. 2021;16:1347-1356. https://doi.org/10.2147/CIA.S308569
  • Orkaby AR, James K, Leuchtenburg J, Solooki E, Gaziano JM, Driver JA. Taking prevention to the next step: implementation of a brief, sustainable frailty assessment in a cardiology clinic. BMJ Open Qual. 2021;10(1):e001140. https://doi.org/10.1136/bmjoq-2020-001140
  • Dharmarajan K, Krumholz HM. Strategies to reduce 30-day readmissions in older patients hospitalized with heart failure and acute myocardial infarction. Curr Geriatr Reports. 2014;3:306–315. https://doi.org/10.1007/s13670-014-0103-8
  • Dodson JA, Hajduk AM, Murphy TE, Geda M, Krumholz HM, Tsang S, et al. Thirty-Day Readmission Risk Model for Older Adults Hospitalized With Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes. 2019;12(5):e005320. https://doi.org/10.1161/CIRCOUTCOMES.118.005320
  • Roffi M, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Kardiol Pol. 2015;73:1207–1294. Polish. https://doi.org/10.5603/KP.2015.0243
  • Rich MW, Chyun DA, Skolnick AH, et al.; American Heart Association Older Populations Committee of the Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council; American College of Cardiology; and American Geriatrics Society. Knowledge gaps in cardiovascular care of the older adult population: a scientific statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society. Circulation. 2016;133:2103–22. https://doi.org/10.1161/CIR.0000000000000380
  • de Vries N.M., Staal J.B., van Ravensberg C.D., Hobbelen J.S.M., Olde Rikkert M.G.M. and Nijhuis-van der Sanden M.W.G. : "Outcome instruments to measure frailty: a systematic review". Ageing Res Rev. 2011;10(1):104-14. https://doi.org/10.1016/j.arr.2010.09.001
  • Fried L., Ferrucci L., Darer J., Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J. Gerontol. Ser. A-Biol. Sci. Med. Sci. 2004; 59 (3): 255–263. https://doi.org/10.1093/gerona/59.3.m255
  • Jones D.M., Song X., Rockwood K. Operationalizing a frailty index from a standardized comprehensive geriatric. American Geriatric Society. 2004; 52: 1929–1933. https://doi.org/10.1111/j. 1532-5415.2004.52 521.x
  • Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, et al., Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging. 2019;23(9):771-787. https://doi.org/10.1007/s12603-019-1273-z
  • Alegre O, Formiga F, López-Palop R, et al. An easy assessment of frailty at baseline independently predicts prognosis in very elderly patients with acute coronary syndrome. J Am Med Dir Assoc. 2018;19:296–303. https://doi.org/10.1016/j.jamda.2017.10.007
  • Myers V, Drory Y, Gerber Y. Clinical relevance of frailty trajectory post myocardial infarction. Eur J Prev Cardiol. 2014;21:758–766. https://doi.org/10.1177/2047487312462828
  • Ekerstad N, Swahn E, Janzon M, et al. Frailty is independently associated with 1-year mortality for elderly patients with non-ST-segment elevation myocardial infarction. Eur J Prev Cardiol. 2014;21:1216–1224. https://doi.org/10.1177/2047487313490257
  • Singh M, Rihal CS, Lennon RJ, et al. Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes. 2011;4:496–502. https://doi.org/10.1161/CIRCOUTCOMES.111.961375
  • Alonso Salinas GL, Sanmartín Fernández M, Pascual Izco M, et al. Frailty predicts major bleeding within 30 days in elderly patients with acute coronary syndrome. Int J Cardiol. 2016;222:590–593. https://doi.org/10.1016/j.ijcard.2016.07.268
  • Blanco S, Ferrières J, Bongard V, et al. Prognosis impact of frailty assessed by the Edmonton Frail Scale in the setting of acute coronary syndrome in the elderly. Can J Cardiol. 2017;33:933–939. https://doi.org/10.1016/j.cjca.2017.03.026
  • Sanchis J, Bonanad C, Ruiz V, et al. Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome. Am Heart J. 2014;168:784–791. https://doi.org/10.1016/j.ahj.2014.07.022
  • Pavasini R, Serenelli M, Celis-Morales CA, et al. Grip strength predicts cardiac adverse events in patients with cardiac disorders: an individual patient pooled meta-analysis. Heart.2019;105(11):834-841. https://doi.org/10.1136/heartjnl-2018-313816
  • Matsuzawa Y, Konishi M, Akiyama E, et al. Association between gait speed as a measure of frailty and risk of cardiovascular events after myocardial infarction. J Am Coll Cardiol. 2013;61:1964–1972. https://doi.org/10.1016/j.jacc.2013.02.020
  • Campo G, Pavasini R, Maietti E, Tonet E, Cimaglia P, Scillitani G, et al. The frailty in elderly patients receiving cardiac interventional procedures (FRASER) program: rational and design of a multicenter prospective study. Aging Clin Exp Res. 2017;29(5):895-903. https://doi.org/10.1007/s40520-016-0662-y
  • Díez-Villanueva P, Arizá-Solé A, Vidán MT, Bonanad C, Formiga F, Sanchis J, et al. Recommendations of the Geriatric Cardiology Section of the Spanish Society of Cardiology for the Assessment of Frailty in Elderly Patients With Heart Disease. Rev Esp Cardiol (Engl Ed). 2019;72(1):63-71. https://doi.org/10.1016/j.rec.2018.06.035
  • Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Eur J Intern Med. 2016;31:3–10. https://doi.org/10.1016/j.ejim.2016.03.007
  • Campo G,, Maietti E,, Tonet E et al. The assessment of scales of frailty and physical performance improves prediction of major adverse cardiac events in older adults with acute coronary syndrome. J Gerontol A Biol Sci Med Sci. 2020;75:1113–9. https://doi.org/10.1093/gerona/glz123