In older adults with cardiovascular Disease (CVD), frailty—defined as decreased physiological reserve and increased vulnerability to stressors—has emerged as a key predictor of poor outcomes. Frailty independently contributes to adverse cardiovascular events, hospitalisation, and mortality, making it essential to distinguish it from chronological ageing. Incorporating frailty assessment into both cardiovascular research and clinical practice is increasingly important for risk stratification and the personalisation of patient care, as supported by growing evidence.

In this narrative review, we examined peer-reviewed studies published between 2011 and 2024 that investigated frailty in older adults with CVD. Search terms included "frailty assessment in cardiovascular studies," "frailty and elderly cardiovascular patients," and "cardiovascular outcomes and frailty scores." Relevant high-impact studies and meta-analyses were identified through databases such as PubMed and Scopus. Frailty assessment tools evaluated in this review included the Hospital Frailty Risk Score (HFRS) and the Fried Frailty Phenotype.

Numerous studies have confirmed an independent association between frailty and adverse cardiovascular outcomes. Frail patients experiencing acute coronary syndromes or undergoing percutaneous coronary interventions have consistently shown higher risks of complications and mortality, as demonstrated by White et al. (2015) and Gharacholou et al. (2012). Assessment tools such as the HFRS (Nguyen et al., 2024) and the Fried criteria (Singh et al., 2011) have shown good predictive accuracy in these populations. Notably, frailty is a dynamic and potentially reversible condition. Early detection of pre-frailty may allow for timely intervention and improved outcomes (Miao et al., 2024). Traditional cardiovascular risk scores often show limited predictive value in older cohorts (Bouillon et al., 2013), and sex-specific differences in the impact of frailty have been reported (Quach et al., 2022), further supporting the need for tailored approaches.

Frailty should be routinely assessed using validated instruments, as it significantly influences cardiovascular prognosis in older adults. Tools such as the Fried Frailty Phenotype and HFRS can enhance risk prediction, guide personalised interventions, and improve clinical outcomes. Recognising frailty as a modifiable and dynamic factor in cardiovascular populations offers an opportunity to implement preventive strategies and support healthy ageing.