Geriatric Assessment to Improve Risk Stratification in Older Patients Undergoing Coronary Revascularization

Abstract

Within the next 20 years, nearly one quarter of the population will be aged ≥65 years.1 Cardiovascular morbidity and mortality rise rapidly after age 65, and this group accounts for 60% of myocardial infarction-related deaths.2 The high burden of comorbid conditions and concomitant lower physiological reserve render this group more complex and fundamentally different from its younger counterparts. Article see p 496 The concept of frailty has gained general acceptance in geriatric medicine as an important prognostic indicator for a range of adverse outcomes. According to current views, frailty can be defined as a physiological state of increased vulnerability to stressors that results from decreased physiological reserves. This reduction in reserve capacity results in difficulty maintaining homeostasis in the face of perturbations, including injury, acute illness, and invasive procedures.3 Although a consensus definition and corresponding assessment tool do not exist yet,4 a widely used operational phenotype for frailty includes 5 criteria: exhaustion, weight loss, low physical activity, weak hand grip, and slow gait speed.5 There is emerging interest in understanding the role of frailty as it pertains to acute coronary care in elderly persons. A previous systematic review found that the prevalence of frailty was >50% among patients with severe coronary artery disease or heart failure and that …