Frailty in peripheral arterial disease

Abstract

It has been consistently demonstrated that frail vascular patients have poorer outcomes compared with their robust counterparts.1 Consideration of frailty is particularly important, not only as our population continues to age but as advances in anaesthetic, surgical and endovascular techniques are enabling a broader range of interventional options for those people who may have traditionally been labelled as unsuitable for surgery.2 Frailty has implications for health and social care at the micro and macro level, and failure to consider the differing needs and natural histories of people living with frailty could result in avoidable harm and suboptimal resource allocation. National guidelines recognise the growing urgency in the need to recognise and manage frailty, yet standardised methods for this have not been identified and agreed upon.3 Despite undeniable prognostic value, the aetiology and pathophysiology of frailty in peripheral arterial disease (PAD) remains poorly understood, albeit new data are emerging. This has challenged a uniform approach to assessment and management. This editorial considers the theories of frailty and applies these to the assessment and management of patients with peripheral arterial disease.