Advancing Cardiogeriatric Care and Frailty Science in Cardiovascular Disease: From Basic Science to Implementation

We are pleased to present this timely special issue of Heart, Lung and Circulation, focused on advancing cardiogeriatric and frailty science in cardiovascular disease management. This issue has been curated by a leading, dynamic team of international experts in frailty and cardiovascular disease (CVD) care, with multidisciplinary representation across nursing, medicine, allied health and basic science.

Cardiovascular disease disproportionately affects older adults. Advances in clinical care, pharmacological therapies, and minimally invasive treatments have extended survival, creating a growing population living with chronic CVD. Older adults often live with two or more cardiovascular conditions, such as atrial fibrillation, coronary artery disease, or heart failure (HF), alongside non-cardiovascular comorbidities and geriatric syndromes, particularly frailty [1–3]. This complex multimorbidity underscores the need for alternative care pathways, moving away from traditional, single-disease-specific management approaches toward innovative, holistic care management [4]. To address and cope with population ageing and the rising tide of multimorbidity, novel approaches and new cardiogeriatric models of care have been proposed.

Frailty syndrome and CVD share a complex bidirectional relationship, from common pathophysiological pathways to overlapping clinical symptoms [5,6]. First conceptualised as a syndrome over two decades ago, frailty is defined as increased vulnerability to acute stressors and decline in homeostatic reserve [7] or as the accumulation of deficits across multiple domains of human functioning [8,9]. Frailty is highly prevalent in people with CVD (up to 80% and 74% in those with HF and aortic valve disease, respectively) [10]. Not only are people with CVD more likely to become frail, but those with CVD and frailty are more likely to have worse outcomes, such as procedural complications, increased length of stay and higher mortality [11]. Despite increased awareness of the effects of frailty on CVD, the widespread implementation of assessment and management pathways in clinical practice has been slow [4].