Frailty in the cardiac intensive care unit: assessment and impact

Abstract

Frailty, a clinical syndrome of increased vulnerability, due to diminished cognitive, physical, and physiological reserves is a growing concern in the cardiac intensive care unit (CICU). It contributes to morbidity, mortality, and complications and often exerts a bidirectional association with cardiovascular disease. Although it predominately affects older adults, frailty can also be observed in younger patients <65 years of age, with approximately 30% of those admitted in CICU are frail. Acute cardiovascular illness can also impair physical and cognitive functioning among survivors and these survivors often suffer from frailty and functional declines post-CICU discharge. Patients with frailty in the CICU often have higher comorbidity burden, and they are less likely to receive optimal therapy for their acute cardiovascular conditions. Given the significance of this geriatric syndrome, this review will focus on assessment, clinical outcomes, and interventions, in an attempt to establish appropriate assessment, management, and resource utilization in frail patients during and after CICU admission.

Keywords: Ageing; Cardiac critical illness; Cardiovascular disease; Frailty; Older adults.

Figure 1

Frailty in the cardiac intensive care unit. Frailty is associated with poor short- and long-term outcomes, but a multimodal approach to management including nutritional support, physical and occupational therapy programmes, prevention of delirium, psychosocial support, and early mobility may impact health outcomes. The authors would like to credit Devon Stuart, MA, CMI, for her valuable assistance with this medical illustration.

Figure 2

Gaps in knowledge and future directions for management of frailty in the cardiac intensive care unit. We would like to thank Devon Stuart, MA, CMI, for her valuable assistance with this medical illustration.