Tag Archives: frailty

Introduction Sodium-glucose cotransporter 2 inhibitors Sodium-glucose cotransporter 2 inhibitors (SGLT2i) demonstrate prognostic benefits independent of glycaemic control, most notably in the EMPA-REG OUTCOME trial.1 Subsequent large-scale randomised-controlled trials (RCTs) of SGLT2i consistently demonstrated improved cardiovascular outcomes irrespective of type 2 diabetes (T2D), extending to populations with heart failure (HF) and chronic kidney disease (CKD). This has culminated in the inclusion of SGLT2i in most T2D, HF and CKD guidelines.2 Frailty There is no universally accepted definition of frailty, which may be understood to be an ag

Introduction Exercise-based cardiac rehabilitation (ExCR) is integral to the management of people with chronic heart failure (CHF).1 It not only improves quality of life (QoL), but is likely to reduce hospital admissions and mortality in this population.1 In response to this evidence, offering a personalised ExCR to all patients with stable CHF is included in the current National Institute for Health and Care Excellence (NICE) guidelines.2 Most CHF diagnoses (up to 80%) occur during an inpatient stay for acute decompensated heart failure (ADHF).3 An admission presents the opportunity for most people with CHF to be offered ExCR. CHF is associa

Introduction Despite notable advances in care, cardiovascular disease remains a leading cause of morbidity and mortality in the UK.1 Currently, about one million people in the UK are living with heart failure (HF), and the prevalence increases significantly with age.1 There is a strong relationship between HF and increasing age, with 80% of all cases occurring in those aged over 60 years.1 Although mortality from HF has declined, the number of people living with disability has increased, particularly among older people.2 Moreover, about 385,000 people are living with undiagnosed and untreated HF, and people can wait up to three years for a d

Introduction Frailty is a distinctive health state, related to the ageing process, in which multiple body systems gradually lose their in-built reserves, and is related to poorer outcomes.1 There have been numerous tools developed to identify frailty,2-4 often these tools are complex and not suitable for identifying patients at the time of admission to hospital, requiring a comprehensive geriatric assessment to validate them. The British Geriatrics Society developed the Frailsafe5,6 checklist, which was piloted across 12 UK hospitals in 2014 as part of the Frailsafe collaborative. The tool used three screening indicators to identify patients

Frailty is strongly associated with cardiovascular disease (CVD) and, while the precise pathophysiological mechanisms linking frailty and CVD remain to be elucidated, it is likely that this association is bi-directional.4,6,7 Loss of muscle mass and function (sarcopaenia), insulin resistance and chronic low-level inflammation observed in the frailty state can predispose to CVD. On the other hand, the presence of CVD can lead to reduced activity, muscle loss and exhaustion, thus, predisposing to frailty. Large cross-sectional and longitudinal studies have shown that those with CVD were up to two to three times more likely to be frail than tho