Frailty in Cardiology: Barriers, Gaps, and Roadmap Forward - JACC Asia Study, November 2025

Distinct barriers to frailty implementation exist at multiple levels, including gaps in provider expertise, insufficient support, and resource constraints that limit adequate frailty care provision in cardiology, according to a study published in November in the Journal of the American College of Cardiology: Asia.

The authors emphasized that addressing the diverse needs of stakeholders will require a comprehensive implementation strategy that leverages interdisciplinary cardio-geriatric team resources and actively involves nurses to improve frailty care in cardiology.

Frailty in Cardiology – Unaddressed in Asia

Frailty has become a central consideration in cardiovascular care as clinicians increasingly encounter older, more medically complex patients whose vulnerability influences prognosis and treatment decisions. Despite this awareness, frailty assessment is often missing from routine cardiology workflows across Asia, leaving a major gap between what clinicians recognize as important and what is consistently practiced. The current research examined this disconnect by exploring why frailty remains difficult to implement in real-world cardiology settings, even as evidence supporting its relevance continues to grow.

Study Overview

To understand these barriers, the investigators conducted a multinational survey involving cardiologists, other physicians, nurses, and allied health professionals from diverse Asian healthcare systems. The survey evaluated how familiar clinicians are with frailty tools, how often frailty is assessed, what challenges clinicians face in incorporating it into their workflow, and what institutional or resource limitations affect implementation. By capturing perspectives from 238 healthcare professionals across different practice environments, the study provides a clear picture of the practical challenges limiting the integration of frailty assessment into everyday cardiovascular care.

Key Findings

The survey revealed that although clinicians broadly recognize frailty as clinically important, routine adoption remains low. Time constraints emerged as a dominant barrier, driven by the fast-paced and procedure-oriented nature of cardiology.

Among all respondents, one-quarter lacked confidence in identifying (22.7%) or treating (28.2%) frailty, and many were uncertain of the screening tools (34.9%) and subsequent steps (37.8%). Other barriers include inadequate multidisciplinary support (21%), communication difficulties (45.8%), resource limitations (52.9%), patient and caregiver unreceptiveness (21.8%), and insufficient community care collaborations (39.5%). Compared with other physicians, cardiologists reported being too busy and having less awareness of screening selection and appropriate assessment tools. Nurses experienced fewer interdisciplinary communication difficulties than cardiologists. There were no significant differences in understanding, support received, and patients’ and caregivers’ receptiveness toward frailty interventions between nurses and cardiologists.

Way Forward for Cardiology Clinicians

Clinically, these results underline the need for cardiology teams to move from conceptual recognition of frailty toward practical, structured assessment. Frailty has direct implications for treatment decisions, procedural risk, recovery trajectories, and long-term outcomes. Yet without workflows that support clinicians—through simplified tools, dedicated time, and multidisciplinary teams, frailty remains underdiagnosed and undertreated. Strengthening collaboration between cardiologists, nurses, and geriatric specialists could help establish more reliable systems for early identification and tailored management of frail patients, particularly in settings where cardiovascular care is delivered at high volume and high speed.

Editorial Perspective: Translating Findings into Practice

The accompanying editorial, by Shuting Liu et al. emphasized that frailty is rapidly becoming one of the central challenges in modern cardiovascular care, driven by an unprecedented rise in the aging population worldwide. With more than two billion adults aged 60 years projected by 2050, the authors stress that frailty will increasingly shape the clinical trajectory of cardiovascular disease. They note that frailty is inherently multidimensional—spanning physical, cognitive, nutritional, and psychosocial vulnerability—and that this complexity influences mortality, treatment tolerance, and recovery in cardiac patients. For this reason, the editorial argues that frailty must be approached not as a single metric but as a broad clinical syndrome requiring coordinated, systematic strategies.

A major theme throughout the editorial is the persistent gap between conceptual consensus and real-world adoption. These include inconsistent assessment practices, lack of structured pathways, limited training, and heterogeneous institutional support. The editorial underscores that these barriers occur at multiple levels—from clinicians who lack time or accessible tools, to hospitals without standardized processes, to health systems that have not yet prioritized frailty within cardiovascular pathways. The authors frame frailty assessment as a workflow issue rather than an awareness issue, urging cardiology teams to move beyond informal or occasional assessments toward consistent and purposeful integration.

Stakeholder engagement is identified as essential. The editorial repeatedly emphasizes that cardiologists cannot carry the workload alone. Instead, effective frailty care requires participation from nurses, allied health professionals, geriatric specialists, and administrative leaders

The authors also point to the need for broader system-level initiatives, including clearer policies, unified definitions, and frameworks that promote consistency across hospitals. Similar system-wide strategies, they argue, will be crucial for moving frailty care from expert consensus to the bedside. They advocate for the development of standardized models that enable reproducible frailty screening, guided decision-making, and ongoing monitoring in cardiovascular pathways.

Final Message

Ultimately, the editorial calls for a coordinated, multilevel effort, spanning frontline clinicians, multidisciplinary teams, and health system leadership to close the current implementation gap. By aligning everyday workflows with structured frailty strategies, the authors believe that cardiology can better serve its rapidly aging patient population and improve long-term clinical outcomes in a meaningful, scalable way.

Reference: 1. Wong JJ, Hong R, Ong TIW, Lim JY, Yan T, Park DW, Tan GHN, Zhang H, Nguyen TTH, Nguyen HTT, Dong Y, Kong WKF, Li S, Tan JWC, Vu HTT, Koh AS. Addressing Frailty in Cardiology: Identifying Barriers Faced by Cardiologists and Health Care Professionals in Asia. JACC Asia. 2025 Nov;5(11):1457-1471. doi: 10.1016/j.jacasi.2025.07.002. Epub 2025 Sep 5. PMID: 40910961.

2. Liu S, Yang Q, Zhou X. Overcoming Implementation Barriers in Frailty Management in Cardiology: From Consensus to Bedside. JACC Asia. 2025 Nov;5(11):1472-1475. doi: 10.1016/j.jacasi.2025.08.014. PMID: 41198376.

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