The Biologic Syndrome of Frailty in Heart Failure

As we continue to care for an older and sicker end-stage heart failure population, it has become challenging to evaluate patients based on current risk scores that mainly focus on subjective symptoms and patient disability. For generations, geriatricians have sought to identify the body’s underlying vulnerabilities that characterize frailty. More recently, cardiologists have begun to recognize this entity in their own practice. Several studies have suggested rates of frailty as high as 50% in patients with cardiovascular disease. However, despite recognizing frailty, it remains difficult to define. Like heart failure, frailty is a biologic syndrome that affects multiple organ systems. Measures of frailty are shown to strongly correlate with adverse outcomes in the health care system.