Aleksandr Martynenko
The 2026 European Society of Cardiology Guidelines for the Management of Cardiovascular Disease and Chronic Kidney Disease provide an integrated framework for cardiorenal risk detection, treatment modification, and health service planning. However, chronological age, kidney function, albuminuria, and conventional cardiovascular risk measures cannot fully capture the clinical heterogeneity of older adults. Frailty, sarcopenia, cognitive impairment, multimorbidity, polypharmacy, and limited life expectancy may substantially alter both the expected benefits and burdens of treatment. Conversely, advanced age alone should not justify withholding evidence-based cardiorenal therapy from functionally preserved older adults. This editorial proposes STAMP-F as a conceptual and currently unvalidated extension of the guideline framework. The additional component represents Frailty, Function, and Future Healthspan and is intended to support individualized decisions rather than serve as an official recommendation, diagnostic criterion, or prognostic instrument. Brief measures such as the Clinical Frailty Scale and gait speed may provide pragmatic entry points for this assessment. Incorporating these domains may help align organ-protective treatment with outcomes that matter to older adults, including mobility, cognition, independence, quality of life, and healthspan. Prospective studies are needed to determine whether this approach improves clinical decision-making and patient-centered outcomes.