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Frailty and Heart Disease

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Cardiac Management in the Frail Elderly Patient and the Oldest Old

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Abstract

The continuous increase of life expectancy is responsible for the increasing number of patients suffering from heart diseases being older than 65 years of age. Moreover, the reduction of mortality due to heart diseases implies that patients survive for longer periods and often reach very advanced age. Frailty, a biological syndrome that reflects a state of decreased physiological reserve and higher vulnerability to stressors, is common in these patients and strongly increases the risk of negative health outcomes. Therefore, it should be systematically assessed, using validated instruments. However, the impact of frailty on the management of heart diseases is still incompletely understood. Until further research clarifies this issue, it is recommended to identify frailty, in order to provide a personalized approach to the treatment of cardiac diseases as well as to implement the interventions that can counteract frailty, including referral for comprehensive geriatric assessment, as needed.

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References

  1. Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, Wolfson C. Frailty: an emerging research and clinical paradigm issues and controversies. J Gerontol A Biol Sci Med Sci. 2007;62:731–7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, Ershler WB, Harris T, Fried LP. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;54:991–1001.

    Article  PubMed  Google Scholar 

  3. Shamliyan T, Talley KMC, Ramakrishnan R, Kane RL. Association of frailty with survival: a systematic literature review. Ageing Res Rev. 2012;12:719–36.

    Google Scholar 

  4. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.

    Article  PubMed  Google Scholar 

  5. Cigolle CT, Ofstedal MB, Tian Z, Blaum CS. Comparing models of frailty: the Health and Retirement Study. J Am Geriatr Soc. 2009;57(5):830–9.

    Article  PubMed  Google Scholar 

  6. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    Google Scholar 

  7. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in older people. CMAJ. 2005;173(5):489–95.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Gutierrez Robledo LM, Rockwood K, von Haehling S, Vandewoude MF, Walston J. Frailty consensus: a call to action. J Am Med Direct Assoc. 2013;14:392–7.

    Article  Google Scholar 

  9. Ekdahl AW, Sjöstrand F, Ehrenberg A, Oredsson S, Stavenow L, Wisten A, Wårdh I, Ivanoff SD. Frailty and comprehensive geriatric assessment organized as CGA-ward or CGA-consult for older adult patients in the acute care setting: A systematic review and meta-analysis. EGM. 2015;6:523–40.

    Google Scholar 

  10. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60:1487–92.

    Article  PubMed  Google Scholar 

  11. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59(3):255–63.

    Article  PubMed  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  13. Serviddio G, Romano AD, Greco A, Rollo T, Bellanti F, Altomare E, Vendemiale G. Frailty syndrome is associated with altered circulating redox balance and increased markers of oxidative stress. Int J Immunopathol Pharmacol. 2009;22(3):819–27.

    Article  CAS  PubMed  Google Scholar 

  14. Schaap LA, Pluijm SMF, Deeg DJH, Visser M. Inflammatory markers and loss of muscle mass (sarcopenia) and strength. Am J Med. 2006;119(6):e9–17.

    Article  Google Scholar 

  15. Fried LP, Xue QL, Cappola AR, Ferrucci L, Chaves P, Varadhan R, Guralnik JM, Leng SX, Semba RD, Walston JD, Blaum CS, Bandeen-Roche K. Nonlinear multisystem physiological dysregulation associated with frailty in older women: implications for etiology and treatment. J Gerontol A Biol Sci Med Sci. 2009;64(10):1049–57.

    Article  PubMed  Google Scholar 

  16. Ostir GV, Berges I, Kuo YF, Goodwin JS, Ottenbacher KJ, Guralnik JM. Assessing gait speed in acutely ill older patients admitted to an acute care for elders hospital unit. Arch Intern Med. 2012;172(4):353–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, Nevitt M, Visser M, Kritchevsky S, Badinelli S, Harris T, Newman AB, Cauley J,Ferrucci L, Guralnik J. Gait speed and survival in older adults. JAMA 2011; 305(1):50–8.

    Google Scholar 

  18. Lo AX, Donnelly JP, McGwin G Jr, Bittner V, Ahmed A, Brown CJ. Impact of gait speed and instrumental activities of daily living on all-cause mortality in adults ≥65 years with heart failure.Am J Cardiol. 2015;115:797–801.

    Google Scholar 

  19. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med. 2012;172:1162–8.

    Google Scholar 

  20. Singh NA, Quine S, Clemson LM, Williams EJ, Williamson DA, Stavrinos TM, Grady JN, Perry TJ, Lloyd BD, Smith EU, Singh MA. Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial. J Am Med Direct Assoc. 2012;13:24–30.

    Article  Google Scholar 

  21. Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care 2009;12:86–90.

    Google Scholar 

  22. Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA, Flicker L, Wark J, Jackson RD, Cauley JA, Meyer HE, Pfeifer M, Sanders KM, Stahelin HB, Theiler R, Dawson-Hughes B. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med. 2012;367:40–9.

    Article  CAS  PubMed  Google Scholar 

  23. Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ. 2011;342:d2040.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, Popma JJ, Ferrucci L, Forman DE. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol. 2014;63(8):747–62.

    Article  PubMed  Google Scholar 

  25. Alexander KP, Newby LK, Cannon CP, Armstrong PW, Gibler WB, Rich MW, Van de Werf F, White HD, Weaver D, Naylor MD, Gore JM, Krumholz HM, OhMan EM, American Heart Association Council on Clinical Cardiology, Society of Geriatric Cardiology. Acute coronary care in the elderly. Part I: non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the AHA Council on Clinical cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation. 2007;15:2549–69.

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  27. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8(1):30–41.

    Article  PubMed  Google Scholar 

  28. Newman AB, Gottdiener JS, McBurnie MA, Hirsch CH, Kop WJ, Tracy R, Walston JD, Fried LP. Associations of subclinical cardiovascular disease with frailty. J Gerontol A Biol Sci Med Sci. 2001;56(3):M158–66.

    Article  CAS  PubMed  Google Scholar 

  29. Woods NF, Lacroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, Masaki K, Murray A, Newman AB. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc. 2005;53:1321–30.

    Article  PubMed  Google Scholar 

  30. Khan H, Kalogeropoulos AP, Georgiopoulou VV, Newman AB, Harris TB, Rodondi N, Bauer DC, Kritchevsky SB, Butler J. 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 

  31. Lupón J, González B, Santaeugenia S, Altimir S, Urrutia A, Más D, Díez C, Pascual T, Cano L, Valle V. Prognostic implication of frailty and depressive symptoms in an outpatient population with heart failure. Rev Esp Cardiol. 2008;61:835–42.

    Article  PubMed  Google Scholar 

  32. Anker SD, Ponikowski PP, Clark AL, Leyva F, Rauchhaus M, Kemp M, Teixeira MM, Hellewell PG, Hooper J, Poole-Wilson PA, Coats AJ. Cytokines and neurohormones relating to body composition alterations in the wasting syndrome of chronic heart failure. Eur Heart J. 1999;20(9):683–93.

    Article  CAS  PubMed  Google Scholar 

  33. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, Jatoi A, Kalantar-Zadeh K, Lochs H, Mantovani G, Marks D, Mitch WE, Muscaritoli M, Najand A, Ponikowski P, Rossi Fanelli F, Schambelan M, Schols A, Schuster M, Thomas D, Wolfe R, Anker SD. Cachexia: a new definition. Clin Nutr. 2008;27(6):793–9.

    Article  CAS  PubMed  Google Scholar 

  34. Fülster S, Tacke M, Sandek A, Ebner N, Tschöpe C, Doehner W, Anker SD, von Haehling S. 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.

    Article  PubMed  Google Scholar 

  35. Morley JE. Anorexia, sarcopenia, and aging. Nutrition. 2001;17(7-8):660–3.

    Article  CAS  PubMed  Google Scholar 

  36. Dahlström U. Frequent non-cardiac comorbidities in patients with chronic heart failure. Eur J Heart Fail. 2005;7(3):309–16.

    Article  PubMed  Google Scholar 

  37. Braunstein JB, Anderson GF, Gerstenblith G, Weller W, Niefeld M, Herbert R, Wu AW. Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. J Am Coll Cardiol. 2003;42(7):1226–33.

    Article  PubMed  Google Scholar 

  38. Cherubini A, Oristrell J, Pla X, Ruggiero C, Ferretti R, Diestre G, Clarfield AM, Crome P, Hertogh C, Lesauskaite V, Prada GI, Szczerbinska K, Topinkova E, Sinclair-Cohen J, Edbrooke D, Mills GH. The persistent exclusion of older patients from ongoing clinical trials regarding heart failure. Arch Intern Med. 2011;171(6):550–6.

    Article  PubMed  Google Scholar 

  39. Murad K, Kitzman DW. Frailty and multiple comorbidities in the elderly patient with heart failure: implications for management. Heart Fail Rev. 2012;17(4-5):581–8.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Ridda I, Lindley R, MacIntyre RC. The challenges of clinical trials in the exclusion zone: the case of the frail elderly. Australas J Ageing. 2008;27(2):61–6.

    Article  PubMed  Google Scholar 

  41. Chaudhry SI, McAvay G, Chen S, Whitson H, Newman AB, Krumholz HM, Gill TM. Risk factors for hospital admission among older persons with newly diagnosed heart failure: findings from the Cardiovascular Health Study. J Am Coll Cardiol. 2013;61:635–42.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Cacciatore F, Abete P, Mazzella F, Viati L, Della Morte D, D’Ambrosio D, Gargiulo G, Testa G, Santis D, Galizia G, Ferrara N, Rengo F. Frailty predicts long-term mortality in elderly subjects with chronic heart failure. Eur J Clin Invest. 2005;35:723–30.

    Article  CAS  PubMed  Google Scholar 

  43. Pulignano G, Del Sindaco D, Di Lenarda A, Tarantini L, Cioffi G, Gregori D, Tinti MD, Monzo L, Minardi G. Usefulness of frailty profile for targeting older heart failure patients in disease management programs: a cost-effectiveness, pilot study. J Cardiovasc Med (Hagerstown). 2010;11:739–47.

    Article  Google Scholar 

  44. von Haehling S, Anker SD, Doehner W, Morley JE, Vellas B. Frailty and heart disease. Int J Cardiol. 2013;168(3):1745–7.

    Article  Google Scholar 

  45. Scott D, Blizzard L, Fell J, Jones G. The epidemiology of sarcopenia in community living older adults: what role does lifestyle play? J Cachexia Sarcopenia Muscle. 2011;2:125–34.

    Article  PubMed  PubMed Central  Google Scholar 

  46. von Haehling S, Morley JE, Anker SD. An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle. 2010;1:129–33.

    Article  Google Scholar 

  47. Anker SD, Swan JW, Volterrani M, Chua TP, Clark AL, Poole-Wilson PA, Coats AJ. The influence of muscle mass, strength, fatigability and bloodflow on exercise capacity in cachectic and non-cachectic patients with chronic heart failure. Eur Heart J. 1997;18:259–69.

    Article  CAS  PubMed  Google Scholar 

  48. Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community. Circulation. 2011;123:2344–52.

    Article  PubMed  Google Scholar 

  49. Singh M, Stewart R, White H. Importance of frailty in patients with cardiovascular disease. Eur Heart J. 2014;35(26):1726–31.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics – 2013 update: a report from the American Heart Association. Circulation. 2013;127(1):143–52.

    Google Scholar 

  51. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB, on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–322.

    Google Scholar 

  52. Lenfant C. Shattuck lecture–clinical research to clinical practice–lost in translation? N Engl J Med. 2003;349(9):868–74.

    Article  PubMed  Google Scholar 

  53. Singh M, Rihal CS, Lennon RJ, Spertus JA, Nair KS, Roger VL. Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circulation. 2011;4:496–502.

    PubMed  PubMed Central  Google Scholar 

  54. Purser JL, Kuchibhatla MN, Fillenbaum GG, Harding T, Peterson ED, Alexander KP. Identifying frailty in hospitalized older adults with significant coronary artery disease. J Am Geriatr Soc. 2006;54:1674–81.

    Article  PubMed  Google Scholar 

  55. Ekerstad N, Swahn E, Janzon M, Alfredsson J, Lofmark R, Lindeberger M, Carlsson P. Frailty is independently associated with short-term outcomes for elderly patients with non-ST-segment elevation myocardial infarction. Circulation. 2011;124:2397–404.

    Article  PubMed  Google Scholar 

  56. Sanchis J, Bonanad C, Ruiz V, Fernández J, García-Blas S, Mainar L, Ventura S, Rodríguez-Borja E, Chorro FJ, Hermenegildo C, Bertomeu-González V, Núñez E, Núñez J. Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome. Am Heart J. 2014;168(5):784–91.

    Article  PubMed  Google Scholar 

  57. White HD, Westerhout CM, Alexander KP, Roe MT, Winters KJ, Cyr DD, Fox KA, Prabhakaran D, Hochman JS, Armstrong PW, Ohman EM, 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. 2015. pii: 2048872615581502. [Epub ahead of print].

    Google Scholar 

  58. Newman AB, Simonsick EM, Naydeck BL, Boudreau R, Kritchevsky SB, Nevitt MC, Pahor M, Satterfield S, Brach JS, Studenski SA, Harris TB. Association of long distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA. 2006;295:2018–26.

    Article  CAS  PubMed  Google Scholar 

  59. Corti MC, Salive ME, Guralnik JM. Serum albumin and physical function as predictors of coronary heart disease mortality and incidence in older persons. J Clin Epidemiol. 1996;49:519–26.

    Article  CAS  PubMed  Google Scholar 

  60. Dumurgier J, Elbaz A, Ducimetière P, Tavernier B, Alpérovitch A, Tzourio C. Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study. BMJ. 2009;339:b4460.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Matsuzawa Y, Konishi M, Akiyama E, Suzuki H, Nakayama N, Kiyokuni M, Sumita S, Ebina T, Kosuge M, Hibi K, Tsukahara K, Iwahashi N, Endo M, Maejima N, Saka K, Hashiba K, Okada K, Taguri M, Morita S, Sugiyama S, Ogawa H, Sashika H, Umemura S, Kimura K. Association between gait speed as a measure of frailty and risk of cardiovascular events after myocardial infarction. J Am Coll Cardiol. 2013;61(19):1964–72.

    Article  PubMed  Google Scholar 

  62. TIME Investigators. Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME). A randomized trial. Lancet. 2001;358:951–7.

    Google Scholar 

  63. Barchielli A, Santoro GM, Balzi D, Carrabba N, Di Bari M, Gensini GF, Filice M, Landini CM, Valente S, Zuppiroli A, Marchionni N. Long-term prognosis after primary PCI in unselected patients with ST-elevation myocardial infarction. J Cardiovasc Med (Hagerstown). 2012;13(12):819–27.

    Article  Google Scholar 

  64. Peterson ED, Alexander KP, Malenka DJ, Hannan EL, O’Conner GT, McCallister BD, Weintraub WS, Grover FL, American Heart Association Chronic CAD Working Group. Multicenter experience in re-vascularization of very elderly patients. Am Heart J. 2004;148:486–92.

    Article  PubMed  Google Scholar 

  65. Pfisterer M, Buser P, Osswald S, Allemann U, Angehrn, Eeckhout E, Erne P, Estilnbaum W, Kuster G, Moccetti T, Naegeli B, Rickenbacher P, for the Trial of Invasive Versus Medical Therapy in Elderly Patients (TIME) Investigators. Outcome of elderly patients with chronic symptomatic coronary artery disease with an invasive vs optimized medical treatment strategy: One-year results of the randomized TIME trial. JAMA. 2003;289:1117–23.

    Google Scholar 

  66. Stoica S, Cafferty F, Kitcat J, Baskett RJF, Goddard M, Sharples LD, Wells FC, Nashef SAM. Octogenarians undergoing cardiac surgery outlive their peers Fa case for early referral. Heart. 2006;92:503–6.

    Article  CAS  PubMed  Google Scholar 

  67. Rosengren A, Wallentin L, Simoons M, Gitt AK, Behar S, Battler A, Hasdai D. Age, clinical presentation, and outcome of acute coronary syndromes in the Euroheart acute coronary syndrome survey. Eur Heart J. 2006;27:789–95.

    Article  PubMed  Google Scholar 

  68. Skolnick AH, Alexander KP, Chen AY, Roe MT, Pollack Jr CV, Ohman EM, Rumsfeld JS, Gibler WB, Peterson ED, Cohen DJ. Characteristics, management, and outcomes of 5,557 patients age ≥90 years with acute coronary syndromes: results from the CRUSADE initiative. J Am Coll Cardiol. 2007;49:1790–7.

    Google Scholar 

  69. Crome P, Cherubini A, Oristrell J. The PREDICT (increasing the participation of the elderly in clinical trials) study: the charter and beyond. Expert Rev Clin Pharmacol. 2014;7(4):457–68.

    Article  CAS  PubMed  Google Scholar 

  70. Gurwitz JH, Col NF, Avorn J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA. 1992;268(11):1417–22.

    Article  CAS  PubMed  Google Scholar 

  71. Lee PY, Alexander KP, Hammill BG, Pasquali SK, Peterson ED. Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA. 2001;286(6):708–13.

    Article  CAS  PubMed  Google Scholar 

  72. Yan RT, Yan AT, Tan M, Chow CM, Fitchett DH, Ervin FL, Cha JY, Langer A, Goodman SG, Canadian Acute Coronary Syndromes (ACS) Registry Investigators. Age-related differences in the management and outcome of patients with acute coronary syndromes. Am Heart J. 2006;151(2):352–9.

    Article  PubMed  Google Scholar 

  73. Zaman MJ, Fleetcroft R, Bachmann M, Sarev T, Stirling S, Clark A, Myint PK. Association of increasing age with receipt of specialist care and long-term mortality in patients with non-ST elevation myocardial infarction. Age Ageing. 2016;45:96–103.

    Google Scholar 

  74. Gnjidic D, Bennett A, Le Couteur DG, Blyth FM, Cumming RG, Waite L, Handelsman D, Naganathan V, Matthews S, Hilmer SN. Ischemic heart disease, prescription of optimal medical therapy and geriatric syndromes in community-dwelling older men: a population-based study. Int J Cardiol. 2015;192:49–55.

    Article  PubMed  Google Scholar 

  75. Di Bari M, Balzi D, Fracchia S, Barchielli A, Orso F, Sori A, Spini S, Carrabba N, Santoro GM, Gensini GF, Marchionni N, Acute Myocardial Infarction in Florence 2 (AMI Florence-2) Working Group. Decreased usage and increased effectiveness of percutaneous coronary intervention in complex older patients with acute coronary syndromes. Heart. 2014;100:1537–42.

    Article  PubMed  Google Scholar 

  76. Turner G, Clegg A, British Geriatrics Society, Age UK, Royal College of General Practioners. 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.

    Article  PubMed  Google Scholar 

  77. Charlemagne A, Blacher J, Cohen A, Colletd JP, Diévarte F, de Grootef P, Hanong O, Leenhardth A, Pineli JF, Pisica-Donosej G, Le Heuzey JY. Epidemiology of atrial fibrillation in France: extrapolation of international epidemiological data to France and analysis of French hospitalization data. Arch Cardiovasc Dis. 2011;104:115–24.

    Article  PubMed  Google Scholar 

  78. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370–5.

    Article  CAS  PubMed  Google Scholar 

  79. Lloyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Ramachandran SV, D’Agostino RB, Massaro JM, Beiser A, Wolf PA, Benjamin EJ. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004;110(9):1042–6.

    Article  PubMed  Google Scholar 

  80. Miyasaka Y, Barnes ME, Gersh B, Cha SS, Bailey KR, Abhayaratna WP, Seward JB, Tsang TS. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114:119–1125.

    Article  PubMed  Google Scholar 

  81. Coppens M, Eikelboom JW, Hart RG, Yusuf S, Lip GYH, Dorian P, Shestakovska O, Connolly SJ. The CHA2DS2-VASc score identifies those patients with atrial fibrillation and a CHADS2 score of 1 who are unlikely to benefit from oral anticoagulant therapy. Eur Heart J. 2013;34(3):170–6.

    Article  CAS  PubMed  Google Scholar 

  82. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DB, Mohler ER, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB, on behalf of the AmericHeart disease and stroke statistics – 2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–292.

    Google Scholar 

  83. Wolf P, Abbott R, Kannel W. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1991;22:983–8.

    Article  CAS  PubMed  Google Scholar 

  84. Appelros P, Nydevik I, Viitanen M. Poor outcome after firstever stroke: predictors for death dependency, and recurrent stroke within the first year. Stroke. 2003;34:122–6.

    Article  PubMed  Google Scholar 

  85. Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EM, D’Agostino RB. Stroke severity in atrial fibrillation. The Framingham Study Stroke. Stroke. 1996;27:1760–4.

    Article  CAS  PubMed  Google Scholar 

  86. Marzona I, O’Donnell M, Teo K, Gao P, Anderson C, Bosch J, Yusuf S. Increased risk of cognitive and functional decline in patients with atrial fibrillation: results of the ONTARGET and TRASCENDENT studies. CMAJ. 2012;184(6):E329–36.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Udompanich S, Lip GY, Apostolakis S, Lane DA. Atrial fibrillation as a risk factor for cognitive impairment: a semi-systematic review. QJM. 2013;106(9):795–802.

    Article  CAS  PubMed  Google Scholar 

  88. Chrischilles E, Segar ET, Wallace RB. Self-reported adverse drug reactions and related re source use. A study of community-dwelling person 65 years of age and older. Ann Intern Med. 1992;117:634–40.

    Article  CAS  PubMed  Google Scholar 

  89. Moore N, Lecointre D, Noblet C, Mabille M. Frequency and cost of serious adverse drug reactions in a department of general medicine. Br J Clin Pharmacol. 1998;45:301–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Wattingey WA, Mensah GA, Croft JB. Increased atrial fibrillation mortality: United States, 1990–1998. Am J Epidemiol. 2002;155:819–26.

    Article  Google Scholar 

  91. Polidoro A, Stefanelli F, Ciacciarelli M, Pacelli A, Di Sanzo D, Alessandri C. Frailty in patients affected by atrial fibrillation. Arch Gerontol Geriatr. 2013;57(3):325–7.

    Article  CAS  PubMed  Google Scholar 

  92. Fumagalli S, Tarantini F, Guarducci L, Pozzi C, Pepe G, Boncinelli L, Valoti P, Baldasseroni S, Masotti G, Marchionni N. Atrial fibrillation is a possible marker of frailty in hospitalized patients: results of the GIFA Study. Aging Clin Exp Res. 2010;22(2):129–33.

    Article  CAS  PubMed  Google Scholar 

  93. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369–429.

    Article  PubMed  Google Scholar 

  94. Hanon O, Assayag P, Belmin J, Collet JP, Emeriau JP, Fauchierd L, Forettea F, Friocourta P, Gentrica A, Leclercq C, Komajda M, Le Heuzey JY, French Society of Geriatrics and Gerantology, French Society of Cardiology. Consensus of the French Society of Geriatrics and Gerontology and the French Society of Cardiology on the management of atrial fibrillation in elderly people. Arch Cardiov Dis. 2013;106(5):303–23.

    Article  Google Scholar 

  95. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW. 2014 AHA/ACC/HRS guideline for the management of [patients with atrial fibrillation: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):2246–80.

    Article  Google Scholar 

  96. Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, Murray E. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007;370(9586):493–503.

    Article  CAS  PubMed  Google Scholar 

  97. Andreotti F, Rocca B, Husted S, Ajjan RA, Ten Berg J, Cattaneo M, Collet JP, De Caterina R, Fox KAA, Halvorsen S, Huber K, Hylek EM, Lip GYH, Montalescot G, Morais J, Patrono C, Verheugt FWA, Wallentin L, Weiss TW, Storey RF. Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J. 2015;36(46):3238–49.

    PubMed  Google Scholar 

  98. Antani MR, Beyth RJ, Covinsky KE, Anderson PA, Miller DG, Cebul RD, Quinn LM, Landefeld CS. Failure to prescribe warfarin to patients with nonrheumatic atrial fibrillation. J Gen Intern Med. 1996;11(12):713–20.

    Article  CAS  PubMed  Google Scholar 

  99. Mendelson G, Aronow WS. Underutilization of warfarin in older persons with chronic nonvalvular atrial fibrillation at high risk for developing stroke. J Am Geriatr Soc. 1998;46(11):1423–4.

    Article  CAS  PubMed  Google Scholar 

  100. Waldo AL, Becker RC, Tapson VF, Colgan KJ. Hospitalised patients with atrial fibrillation and a high risk of stroke are not being provided with adequate anticoagulation. J Am Coll Cardiol. 2005;46(9):1729–36.

    Article  PubMed  Google Scholar 

  101. Perera V, Bajorek BV, Matthews S, Hilmer SN. The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation. Age Ageing. 2009;38(2): 156–62.

    Article  PubMed  Google Scholar 

  102. Bo M, Li Puma F, Badinella Martini M, Falcone Y, Iacovino M, Grisoglio E, Bonetto M, Isaia G, Ciccone G, Isaia GC, Gaita F. Health status, geriatric syndromes and prescription of oral anticoagulant therapy in elderly medical in-patients with atrial fibrillation: a prospective observational study. Int J Cardiol. 2015;187:123–5.

    Article  CAS  PubMed  Google Scholar 

  103. De Breucker S, Herzog G, Pepersack T. Could geriatric characteristics explain the under-prescription of anticoagulation therapy for older patients admitted with atrial fibrillation?: a retrospective observational study. Drugs Aging. 2010;27(10):807–13.

    Article  PubMed  Google Scholar 

  104. Ferguson C, Inglis SC, Newton PJ, Middleton S, Macdonald PS, Davidson PM. Frailty and thromboprophylaxis prescription in heart failure and atrial fibrillation: preliminary findings from the atrial fibrillation and stroke thromboprophylaxis in heart failure (AFASTER) cohort study. Global Heart. 2014;9(1):e264.

    Article  Google Scholar 

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Authors and Affiliations

  1. Geriatria ed Accettazione Geriatrica d’urgenza, IRCCS-INRCA, Ancona, Italy

    Antonio Cherubini & Fabiana Mirella Trotta

  2. Department of Clinical and Experimental Science, University of Brescia, Health & Wealth, Brescia, Italy

    Alessandra Marengoni

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  1. Antonio Cherubini
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  2. Fabiana Mirella Trotta
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  3. Alessandra Marengoni
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Correspondence to Antonio Cherubini .

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Editors and Affiliations

  1. Hypertension Centre - Syncope Unit, Geriatrics Intensive Care Unit University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Andrea Ungar

  2. Professor of Internal Medicine-Geriatrics University of Florence Director, Cardiothoracovascular Department Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Niccolò Marchionni

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Cherubini, A., Trotta, F.M., Marengoni, A. (2017). Frailty and Heart Disease. In: Ungar, A., Marchionni, N. (eds) Cardiac Management in the Frail Elderly Patient and the Oldest Old. Springer, Cham. https://doi.org/10.1007/978-3-319-43468-1_4

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