Moving from just measuring, to acting on frailty in specialties outside geriatrics

The systematic review and meta-analysis by Li et al. investigating the association of frailty with outcomes after cardiac resynchronisation demonstrates what innumerate previous meta-analyses in other specialties have shown: frailty is associated with worse outcomes [1]. This should come as no surprise. By definition, frailty is a health state in which there is “an increase in an individual’s vulnerability for developing increased dependency and/or mortality when exposed to a stressor” [2]. Thus any intervention, being themselves stressors, will naturally lead to impaired recovery, greater burden of complications and adverse events and therefore worse outcomes among those with frailty [3]. The challenge for clinicians is not therefore just to identify frailty in patients considered for interventions, but how to use this knowledge to make better shared decisions and mitigate the increased risks to those with frailty.