In the last decade the number of patients undergoing invasive procedures for cardiovascular disease (e.g: percutaneous coronary intervention, valvuloplasty, percutaneous valve implantation, pacemakers or defibrillator implantation) is increasing, thanks to the increasing expertise of hub centres, the high number of available procedures and distribution of resources.
However, patients admitted in Cardiology unit are getting older. This change in the epidemiology of cardiac patients represents a new challenge for Cardiologists that increasingly have to deal with frail patients.
As a result of frailty, chronological age differs from biological age.
Frailty is defined as a complex clinical syndrome that leads to an increased vulnerability to stressors. Frailty includes weakness, slowness, low level of physical activity, low energy or self- reported exhaustion and unintentional weight loss. Frail patients are usually older, and with several comorbidities. As a result of frailty, chronological age differs from biological age, making it difficult to identify patients at high risk of an adverse event after invasive procedures, relying on age for risk evaluation.
Currently, there are several tools validated to test frailty. Short physical performance battery (SPPB) is one of these and it is mainly an instrument to assess lower extremity physical performance status. It consists of three timed tasks: standing balance, walking speed, and chair stand tests. Every task may account a score between 0 and 4; the total SPPB score ranges from 0 (worst performance) to 12 (best performance).
SPPB is a prognostic indicator for disability and hospital admissions. Several studies also valued the predictive role of this test for all-cause mortality. Our meta-analysis showed that a SPPB value below 10 predicts all-cause mortality in different clinical settings, geographical areas, and independently by age and follow-up lengths.
(SPPB) consists of three timed tasks: standing balance, walking speed, and chair stand tests.
According to the results of this meta-analysis, new studies could be planned to state the role of SPPB as a marker for tailoring the best management for elderly patients with cardiovascular disorders needing invasive procedure.
The “frailty in elderly patients receiving cardiac interventional procedures (FRASER) program” (NCT02386124) is an on-going multicentre prospective trial enrolling patients aged >70 years and admitted to hospital for acute coronary syndromes. One of the aims of this study is to investigate the prognostic role of SPPB score in this particular cardiologic population with a composite primary outcome of one-year all-cause mortality and hospital readmission for any cause.
Results of this trial will better clarify: i) if frailty could be considered a new cardiac risk factor useful also to discriminate patients who really benefit from an invasive strategy and, ii) if SPPB would be a suitable tool to assess frailty also in the hand of Cardiologists.
In the future Cardiologists will increasingly have to deal with issues of internal medicine, once again proving that even the most specific cardiac disease is instead a part of a continuum of disorders that represent the complexity of human pathophysiology.