Beyond chronological age: use of frailty scales for decision-making in cardiovascular interventions

This invited editorial refers to ‘Clinical Outcomes Following Invasive Cardiovascular Interventions in Frail Populations: A Systematic Review and Meta-analysis’, by H. Jiang et al. https://doi.org/10.1093/ehjqcco/qcaf109 Frailty is a multidimensional dynamic state of decreased physiological reserve, representing a process of accelerated ageing and increased vulnerability to stressors.1 It is highly prevalent among patients with cardiovascular disease, carrying an increased risk of morbidity and mortality. In the current issue of the Journal, Jiang et al. present a comprehensive systematic review and meta-analysis on the impact of frailty across diverse invasive procedures, including percutaneous coronary interventions (PCI), cardiac surgery, device implantation, arrhythmia ablation, and transcatheter valve interventions.2 By pooling data from 31 studies with a total of 27 534 patients, the study showed that overall, frailty is followed by a three-fold higher risk of all-cause mortality, a two-fold higher risk of cardiovascular mortality and a 2.3-fold higher risk of major adverse cardiovascular events (MACE) in patients undergoing invasive cardiovascular interventions. Interestingly, the authors also showed that frailty modifies variably the outcomes of different interventions. Thus, coronary revascularization either performed surgically or by PCI, seems to carry a higher risk of all-cause mortality in frail patients compared with non-frail ones. Similarly, surgical aortic valve replacement (SAVR) was followed by higher mortality in frail patients, but this was not the case for transcatheter aortic valve implantation (TAVI), in which frailty was not associated with an excess risk of mortality or MACE, except for major bleeding. Accordingly, frailty did not increase the risk of atrial fibrillation recurrence after catheter ablation.