ABC | Volume 112, Nº5, May 2019

Updated Updated Geriatric Cardiology Guidelines of the Brazilian Society of Cardiology – 2019 Arq Bras Cardiol. 2019; 112(5):649-705 Table 1 – Percentage distribution of the elderly population by sex and age 1 Men Women Total 60 to 69 56.5 56.3 56.4 70 to 79 30.7 29.4 30 80 to 89 10.8 12.2 11.6 90 or over 2 2.1 2 Total 100 100 100 Brazil, 2013. Table 2 – Proportion of elderly people with chronic diseases by number of pathological conditions 1 Men Women Total None 26.9 18.8 22.3 1 to 2 49.4 48 48.6 3 or more 23.7 33.3 29.1 Brazil, 2013. Table 3 – Main causes of death in the elderly population by age 2 Men Women Circulatory system diseases 34.2 35.2 Neoplasm 19 15.5 Respiratory system diseases 14.3 14.7 Endocrine, nutritional, and metabolic diseases 6.5 8.9 Poorly defined 6.2 6.2 Others 19.9 19.5 Total 100 100 Brazil, 2013. Table 4 – Main causes of death due to circulatory system disease by sex 2 Men Women Acute myocardial infarction 26 21.4 Strokes not specified as hemorrhagic or ischemic 13.7 13.7 Heart failure 8.2 9.4 Others 52 55.5 Total 100 100 Brazil, 2013. higher likelihood of contracting a disease than men, 81.2%, compared to 73.1%. This higher proportion of women in the elderly age group means a higher proportion of people with chronic morbidity 1 (Table 2). Within diseases reported, cardiovascular diseases (CVD) are predominant. For example, 62.0% of men and 67.4% of women declare that they have hypertension, and 23.2% and 36.9% of men and women, respectively, declare high cholesterol. These diseases also constitute the main cause of death in the elderly population, accounting for 34.2% and 35.2% of deaths in men and women, respectively. Within CVD, acute myocardial infarction (AMI) and stroke stand out 2 (Tables 3 and 4). This indicates a greater need for prevention, with lifestyle changes, alcohol and tobacco control, better diet, and physical exercise being able to contribute to a reduction in CVD. In summary, it is possible to affirm that humanity seems to be making the dream of long life come true, but it is necessary to avoid the Tithonus trap. Tithonus was a mythical Trojan hero who was granted eternal life; he forgot, however, to ask for eternal youth. Eventually he was transformed into a cricket. Ulysses, on the other hand, declined the gift of immortality, Ulysses, on the other hand, declined the gift of immortality, preferred remain owner of his destiny and his soul (Homero). Or be it, living a long life, with autonomy, should be humanity’s dream. 1.2. Interpretation of Frailty Frailty is a biological syndrome characterized by decreased homeostatic reserve and resistance to various stressors. It results in cumulative decreases in multiple physiological systems and leads to increased vulnerability and unfavorable clinical outcomes, such as falls, impaired mobility and functional decline, hospitalization, institutionalization, and a higher risk of death. 3 This state of vulnerability causes an apparently minor injury (e.g., infection, introduction of a new medication, or even a small surgery) to lead to an evident, disproportional change in the patient’s state of health; these changes may by exemplified as alterations from independent to dependent status, from able to move to immobile, from balance and stable gait speed to risk of falling, or from lucid to delirious. 4,5 There is an overlap, but not a concurrence in the incidence of frailty, incapacity, and multimorbidity (coexistence of two or more chronic diseases). Although they are less frequent, there are frail individuals who have neither incapacity nor multimorbidity. 4 Sarcopenia (decreased muscle mass and function) is a component of the syndrome of frailty, which is more multifaceted and complex than sarcopenia alone. 5 Clinical presentation results not only from a single well defined disease, but rather from the accumulation of impairments in multiple organic systems, and it occurs when the accumulated effects of these impairments compromises the organism’s compensatory capacity. A systematic review demonstrated that the prevalence of frailty among community- dwelling elderly people was 10.7% (varying from 4.0% to 59.1%). 6 In CVD patients, frailty confers a 2-fold risk of death, and this effect continues after adjusting for comorbidities and age. Numerous studies have also demonstrated an increase in the prevalence of frailty among patients with CVD, such as coronary artery disease (CAD), heart failure (HF), heart valve 655