Assessing Frailty-Specific Treatment Effect in Cardiovascular Disease: A Systematic Review
Issued Date
2024-01-01
Resource Type
ISSN
1170229X
eISSN
11791969
Scopus ID
2-s2.0-85210151387
Journal Title
Drugs and Aging
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SCOPUS
Bibliographic Citation
Drugs and Aging (2024)
Suggested Citation
Zhong L., Thanapluetiwong S., Xu K., Ko D., Kim D.H. Assessing Frailty-Specific Treatment Effect in Cardiovascular Disease: A Systematic Review. Drugs and Aging (2024). doi:10.1007/s40266-024-01157-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/102244
Title
Assessing Frailty-Specific Treatment Effect in Cardiovascular Disease: A Systematic Review
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Abstract
Background: Clinicians are increasingly considering using frailty assessments to individualize treatment for older patients. It remains uncertain whether interventions to reduce cardiovascular disease (CVD) events offer similar benefits between older adults with and without frailty. Methods: A systematic literature search was undertaken in PubMed and Embase, adhering to PRISMA guidelines. Key inclusion criteria were randomized controlled trials published between January 2007 and September 2024 with CVD outcomes as an endpoint and data on frailty-specific treatment effects. Data were collected for population characteristics, intervention, follow-up time, frailty measure, outcome rates, and frailty subgroup treatment effect. Due to heterogeneity among the studies, the results were not pooled. Results: The search identified 151 unique studies, of which 18 were included. Using Cochrane Risk of Bias 2.0, 12 out of the 18 studies have low risk of bias. The intervention was more effective in frail participants than in non-frail counterparts in two studies (e.g., aerobic exercise), less effective in frail participants in three studies (e.g., intensive lifestyle intervention), similarly effective across frailty levels in seven studies (e.g., prasugrel), and inconclusive in six studies (e.g., edoxaban). Some treatments were similarly effective across frailty level by hazard ratio but had a greater reduction in absolute risk for frail versus non-frail patients. Conclusions: Cardiovascular interventions may provide differential benefits by patients’ frailty. These findings suggest the potential utility of frailty assessment for optimizing cardiovascular interventions.