Clinical Academic Training

Multimorbidity at Any Age (project 1) – Anaesthetics/Cardiothoracic Surgery/Cardiology

Understanding the role of frailty in long-term management of cardiovascular disease

  • Iain Squire
  • Shirley Sze
  • Gavin Murphy

Frailty (multiple organ systems lose capacity) and multimorbidity (≥2 long term conditions) are two related, but distinct conditions. One in ten adults ≥65 and >50% of those >85 years have frailty. Multimorbidity and frailty, alone or in combination, impact adversely on quality of life, and are associated with increased risk of hospitalisation and death, and with estimated UK health care costs of £5.8 billion/year. Across the spectrum of cardiovascular (CV) disease, frailty is associated with barriers to access to diagnostic and definitive treatment pathways. Frailty as a research priority aligns with the NIHR National Priority Research Programme. 

Frailty and multimorbidity are poorly understood; prevention strategies are lacking and trials of novel interventions often exclude frail / multimorbid patints, leaving significant gaps in knowledge about effective management strategies for patients. Building on our previous work on frailty in patients with heart failure the research will consider the role of frailty / multimorbidity in patients with acute and chronic CV conditions (acute coronary syndrome, heart failure, valvular heart disease, TAVI, cardiac arrhythmia, cardiac surgery). We will address whether comprehensive frailty assessment in patients with CV disease leads to better outcomes via improved clinical decision making. The aims of this research are (1) To summarise current evidence for the use of frailty tools in acute and chronic CV conditions (2) Develop stakeholder commitment through patient and public involvement; (3) Assess the prevalence of frailty in different CV conditions (4) Establish if there are comorbidity clusters in frail patients with CV conditions (5) The impact of frailty on clinical outcomes; (6) Assess the effect of clinical intervention (eg TAVI) on frailty (7) Evaluate fat and muscle distribution of patients with different degrees of frailty (whole body MRI); (8) Develop an intervention to prevent, risk stratify and improve outcomes in frail patients with CV pathology.  

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