Addressing Frailty in Cardiology

Preventing frailty is crucial for improving outcomes in aging populations at heightened cardiovascular risk, yet implementation in real-world practice remains challenging. The authors previously reported low use of frailty strategies among cardiologists in Asia. The aim of this study was to explore the barriers to frailty implementation among cardiologists, other physicians, and nurses. A multinational web-based survey was conducted targeting health care communities across Asia. Among 238 respondents (median age 34.0 years; IQR: 12 years; 63.4% women), 172 were doctors, 57 nurses, and 8 allied health professionals. Among doctors, 59 were cardiologists representing various subspecialties, including critical care cardiology, interventional cardiology, and general cardiology. Among all respondents, one-quarter lacked confidence in identifying (22.7%) or treating (28.2%) frailty, and many were uncertain of the screening tools (34.9%) and subsequent steps (37.8%). Other barriers include inadequate multidisciplinary support (21%), communication difficulties (45.8%), resource limitations (52.9%), patient and caregiver unreceptiveness (21.8%), and insufficient community care collaborations (39.5%). Compared with other physicians, cardiologists reported being too busy (P = 0.041) and having less awareness of screening selection (P = 0.018) and appropriate assessment tools (P = 0.008). Nurses experienced fewer interdisciplinary communication difficulties (P = 0.003) than cardiologists. There were no significant differences in understanding, support received, and patients' and caregivers' receptiveness toward frailty interventions between nurses and cardiologists. Distinct barriers to frailty implementation exist at multiple levels, including gaps in provider expertise, insufficient support, and resource constraints that limit adequate frailty care provision. To address the diverse needs of stakeholders, a comprehensive implementation strategy leveraging interdisciplinary cardiogeriatric team resources and involving nurses could improve frailty care in cardiology.