An Expert Opinion on the Management of Frailty in Heart Failure from the Australian Cardiovascular Alliance National Taskforce.

Ingrid Hopper, Jamie Vandenberg, Meng Hsu, Catherine Shang, Gursharan K Singh, Louise D Hickman, Mai H Duong, Beata V Bajorek, Lindsay Wu, Andrew Maiorana, Anthony Villani, Kim Delbaere, Marc Sim, Richard I Lindley, Sunita R Jha, Bridie Carr, Sarah N Hilmer, Quan Huynh, Anthony Keech, Patricia M Davidson, John J Atherton, Ruth E Hubbard, Peter S Macdonald, Elsa Dent, Caleb Ferguson, Julee McDonagh, Andrea Driscoll

Journal: Heart, lung & circulation 2025;34(7):693-703

PMID: 40107957

Free Full Text on Elsevier Science View on PubMed

Abstract

Approximately 50% of all adults with heart failure (HF) are classified as frail. Frailty is a clinical state of 'accelerated ageing' that complicates management and results in adverse health outcomes. Despite recommendations for frailty assessment in HF guidelines, its implementation into routine clinical practice has been slow. Further, evidence to inform models of care and pharmacological treatment for individuals with HF who are classified as frail is lacking. The complexity of management underscores the importance of tailoring models of care that can improve the focus on frailty through multidisciplinary care teams. Frailty can be reduced in some cases through the comprehensive geriatric assessment model of care, integrating treatment pillars such as exercise, nutrition, social engagement and support networks, and optimised medication use. A national agenda for action on frailty in the context of HF is needed to advance policy, practice, education, and research improve health outcomes for individuals affected. In November 2023 the Australian Cardiovascular Alliance (ACvA) facilitated a national workshop on frailty and HF with key experts. This has led to the development of a frailty and HF national taskforce with the aim to address major priorities and unmet needs. This statement is first step for the taskforce in implementing a national agenda for the management of frailty in HF. Here we outline key considerations for policy, practice, education, and research in Australia.

Address: School of Nursing, Faculty of Science, Medicine & Health, The University of Wollongong, Wollongong, NSW, Australia; Centre for Chronic and Complex Care Research, Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, Australia. Electronic address: [email protected].; School of Nursing, Faculty of Science, Medicine & Health, The University of Wollongong, Wollongong, NSW, Australia; Centre for Chronic and Complex Care Research, Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, Australia.; Kolling Institute, Northern Sydney Local Health District and The University of Sydney, St Leonards, NSW, Australia.; The Australian Frailty Network, Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia; Princess Alexandra Hospital, Woolloongabba, Brisbane, Qld, Australia.; Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; George Institute for Global Health, Sydney, NSW, Australia.; Centre for Quality and Patient Safety, Monash Health & Deakin University, Melbourne, Vic, Australia; Department of Cardiology, Austin Health, Heidelberg, Vic, Australia.; Curtin School of Allied Health, Faculty of Health Sciences, Perth, WA, Australia; Exercise Physiology Department, Fiona Stanley Hospital, Perth, WA, Australia.; Laboratory for Ageing Research, University of New South Wales, Sydney, NSW, Australia.; Department of Cardiology, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.; College of Health, Medicine, and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia; Pharmacy Department, John Hunter Hospital, Hunter New England Local Health District, New Lambton, NSW, Australia.; Agency for Clinical Innovation, Cardiac Network, NSW Government, NSW, Australia.; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia; School of Population Health, University of New South Wales, Sydney, NSW, Australia.; Institute for Evidence-Based Health Care, Bond University, Robina, Qld, Australia.; Kolling Institute, Northern Sydney Local Health District and The University of Sydney, St Leonards, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.; School of Nursing, Faculty of Science, Medicine & Health, The University of Wollongong, Wollongong, NSW, Australia.; Department of Cardiology and General Medicine Unit, Alfred Health, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia.; Notre Dame University, Sydney, NSW, Australia.; Faculty Medicine and Health, Cardiovascular Research, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.; Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, WA, Australia; Medical School, The University of Western Australia, Perth, WA, Australia.; Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia.; School of Health, University of the Sunshine Coast, Birtinya, Qld, Australia.; Australian Cardiovascular Alliance, Sydney, NSW, Australia.; The Victor Chang Cardiac Research Institute, Darlinghurst, NSW Australia.; The Victor Chang Cardiac Research Institute, Darlinghurst, NSW Australia; Heart Lung Clinic, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; School of Clinical Medicine, University of New South Wales, NSW, Sydney, Australia.

DOI: 10.1016/j.hlc.2025.01.012