Frailty and Coronary Artery Disease: Proposed Pathophysiology and A Complex Interaction Influencing Management and Outcomes in Older Adults

Coronary artery disease (CAD) and frailty frequently coexist in older adults and represent a growing clinical challenge in the context of an ageing population. Frailty, a multidimensional syndrome characterised by reduced physiological reserve and increased vulnerability to stressors, is highly prevalent among older patients with CAD and is associated with adverse outcomes. This review examines the complex interplay between frailty and CAD, highlighting shared pathophysiological mechanisms, and further explores the impact of frailty on clinical presentation, risk stratification and therapeutic decision-making in CAD. A range of frailty assessment tools are discussed, although no single tool has been universally adopted in cardiovascular practice. The presence of frailty influences the utilisation and outcomes of pharmacological therapies, invasive strategies, and cardiac rehabilitation, often contributing to treatment disparities. Incorporating frailty assessment into routine cardiovascular care may improve individualised management and shared decision-making. Future research should prioritise frailty inclusive clinical trials and integrated cardiogeriatric approaches to optimise outcomes in this vulnerable population.