Search Results (374)

Background/Objectives: Chronic diseases account for 74% of global deaths, with multimorbidity (existence of more than one chronic condition) increasing disability risk and treatment burden, leading to poor adherence, disease progression, and reduced quality of life. Nursing-led proactive care models that focus on patient engagement, education, and self-care can help mitigate these challenges. The study aims to evaluate the effectiveness of a nurse-led proactive health intervention in improving care for individuals with chronic diseases in general practice. Methods: A quasi-experimental pre–post study will be conducted in a Community Health Home in Northern Italy. Family and community nurses will deliver the intervention, which includes assessments, educational sessions, and follow-ups for patients aged 65+ with at least one chronic condition. Recruitment will occur over three months. Results: Primary outcomes include emergency department visits and hospitalizations, while secondary outcomes focus on medication adherence, self-care, and service utilization. Data will be collected at 6 and 12 months, and statistical analysis will use descriptive methods and generalized estimating equations (GEEs). Conclusions: This study will improve the understanding of the value of nurse-led proactive intervention, filling the gap in the literature by testing evidence-based approaches on a realistic frail population. Moreover, delivering a complex but structured intervention will provide evidence for future interventions to reduce treatment burden and improve health outcomes. Full article

Background/Objectives: Obstructive sleep apnea (OSA) and related sleep disorders affect a substantial proportion of hospitalized patients, with an estimated 48% pooled prevalence of undiagnosed OSA in cardiac inpatients and up to 80% of moderate-to-severe community OSA cases carrying no formal diagnosis at the time of hospital admission. In parallel, frailty—a state of heightened physiological vulnerability arising from cumulative multi-system biological decline—is present in 40–80% of inpatients and shares deep, bidirectional neurobiological pathways with sleep-disordered breathing through circadian dysregulation, intermittent hypoxia, hypothalamic–pituitary–adrenal axis activation, and chronic low-grade inflammation. Despite this convergence, no prior study has integrated validated, administratively computable frailty phenotyping with a machine learning framework specifically designed to predict inpatient sleep disorder diagnosis—and OSA in particular—at the point of hospital admission. The present study addresses this gap by developing an admission-time, explainable machine learning framework for the prediction of inpatient sleep disorder diagnoses (ICD-10 G47.x, encompassing OSA G47.3, insomnia G47.0, hypersomnia, and circadian rhythm disorders) and of insomnia specifically (ICD-10 G47.00). Methods: We developed and evaluated a suite of five binary classification models—XGBoost, Random Forest, LightGBM, CatBoost, and Decision Tree—using 9682 balanced hospitalization episodes from the MIMIC-IV (version 2.2) database. The predictor set comprised 23 admission-time structured features across three domains: (i) frailty and comorbidity burden, including the Hospital Frailty Risk Score (HFRS) derived from ICD-10 codes, the Elixhauser comorbidity index, prior admission history, and six binary disease flags (obesity, hypertension, type 2 diabetes, heart failure, COPD, and depression/anxiety); (ii) physiological and laboratory biomarkers from the first 24 h of care, including minimum SpO₂, heart rate variability, hemoglobin, creatinine, albumin, and arterial blood gas parameters; and (iii) sociodemographic and administrative variables encompassing age, sex, ethnicity, insurance type, and admission acuity. Model performance was assessed through five-fold stratified cross-validation and bootstrap confidence intervals (n = 1000 iterations), with predictor importance quantified using SHapley Additive exPlanations (SHAP). Results: XGBoost achieved the strongest aggregate performance across all evaluation metrics, attaining an area under the receiver operating characteristic curve (AUC) of 0.871 (95% CI: 0.856–0.887), accuracy of 79.6%, F1-score of 0.820, and sensitivity of 94.9%, correctly identifying 903 of 952 true positive cases in the held-out test set; all gradient boosting frameworks substantially outperformed the Decision Tree baseline (AUC 0.836). SHAP analysis identified the HFRS and Elixhauser index as the two dominant predictors, followed by depression/anxiety, obesity, hypertension, and minimum SpO₂—a hierarchy that recapitulates the canonical clinical phenotype of obstructive sleep apnea in frail inpatients rather than that of primary insomnia, indicating that the model is preferentially capturing the OSA–frailty axis within the broader G47.x outcome. The predicted probability outputs were well-calibrated across all risk deciles. Conclusions: Frailty-derived features, in combination with admission-time clinical and physiological data, can predict inpatient sleep disorder diagnoses—predominantly OSA—with high sensitivity and well-calibrated risk estimates. The deployable, interpretable nature of the XGBoost model makes it directly suitable for integration into clinical decision support systems, offering a screening tool that requires no dedicated instrumentation beyond routine admission data. By flagging high-risk patients at the moment of admission, the framework provides a concrete mechanism for accelerating referral for definitive diagnostic confirmation (overnight oximetry, polysomnography) and earlier initiation of CPAP and related therapies, with direct implications for reducing the persistent diagnostic gap, perioperative risk, and preventable adverse outcomes in frail hospitalized populations. Full article

The coexistence of obesity, osteoporosis, and sarcopenia has been associated with adverse outcomes such as risk of falls, fractures, immobility, disability and frailty, yet data from Latin American populations are scarce. This study aimed to determine the prevalence and associations of obesity, osteoporosis, and sarcopenia—individually and combined—with frailty in Mexican elderly women. We conducted a cross-sectional study in which patients with body mass index < 18.5 kg/m², uncorrected sensory deficits, immobility, musculoskeletal diseases, or patients with implanted devices were excluded. Frailty was assessed using the FRAIL scale, obesity by body fat percentage, osteoporosis according to American Association of Clinical Endocrinology (AACE) guidelines and sarcopenia following the European Working Group on Sarcopenia in Older People-2 (EWGSOP2) recommendations. A total of 115 participants aged ≥60 years were assessed between January and June 2025. Frailty was present in 21.7% of the patients; 67.0% had obesity, 72.2% osteoporosis, 20.0% sarcopenia and 13.0% osteosarcopenic obesity. Sarcopenic phenotypes were associated with frailty: odds ratios (95% CI) were 3.05 (1.12–8.26) for sarcopenia, 4.23 (1.42–12.55) for sarcopenic obesity and 3.98 (1.28–12.40) for osteosarcopenic obesity. Sarcopenic phenotypes showed associations with frailty in Mexican elderly women. Full article

Background/Objectives: Population ageing is accompanied by an increasing burden of multimorbidity and frailty, both of which are consistently associated with poorer health-related quality of life (QoL). Although several geriatric domains influence QoL in older adults, their combined association remain insufficiently explored in institutionalised populations. This study aimed to examine the independent and combined associations between age, multimorbidity, frailty, and QoL in institutionalised older adults and to explore which quality-of-life domain was most strongly associated with geriatric assessment variables. Methods: A cross-sectional study was conducted in 72 institutionalised older adults in Spain. Multimorbidity (number of chronic conditions), frailty (Fried phenotype), functional status, nutritional status, fall risk, and QoL were assessed using validated instruments, including the World Health Organization Quality of Life questionnaire. Pearson correlations and canonical correlation analysis were used to examine relationships between geriatric assessment variables and QoL domains. Analysis of variance and regression tree were subsequently applied to explore associations affecting the Physical Health domain. Results: A correlation analysis identified the Physical Health domain as the QoL dimension most strongly associated with geriatric variables. On the other hand, frailty, age and number of chronic diseases turned out to be the most explanatory in our study and were classified: the first according to the standard protocol, and the other two using a regression tree. Then, a three-way additive ANOVA explained 36.4% of the variance, with age as main influential. Namely, we estimate that the poorest QoL occurs in subjects over 84 who have more than three chronic conditions and are classified as frail. However, this is not a validated clinical decision rule since these cutoff points may vary in other samples. Conclusions: In this sample of institutionalised older adults, age emerged as the main variable associated with lower physical QoL, multimorbidity contributes to the cumulative burden of disease, and frailty may reflect the systemic decline in physiological reserves. Full article

Chronic respiratory diseases (CRDs) represent a significant global mortality burden, largely driven by viral-triggered exacerbations. In the elderly, susceptibility to viral pathogens is critically linked to the “interferon gap”—a kinetic delay in innate antiviral signaling resulting from immunosenescence and Th2-skewed inflammaging. While traditional vaccines provide pathogen-specific protection, their efficacy is often compromised by age-related immune hyporesponsiveness and antigenic drift. This perspective paper proposes a dual-phase, virus-agnostic immunomodulatory platform designed to restore mucosal immune competence and provide a rapid-response intervention for incipient exacerbations. Rather than acting as a pathogen-specific vaccine, the platform serves as a comprehensive host immune-rejuvenation engine and cellular adjuvant platform. The platform consists of two integrated stages: Allopriming and Alloantigen Inhalation Recall (AIR). Allopriming utilizes AlloStim^® (activated, allogeneic Th1 cells) to leverage the evolutionarily conserved allo-rejection response, establishing a lung mucosal reservoir of allo-specific Th1 tissue-resident memory cells (Trm). Building on previously published Phase I/II data showing that Allopriming reverses biomarkers of immunosenescence and sustains durable heterologous antiviral responsiveness, the AIR strategy is introduced as a patient-administered rescue mechanism for frail CRD patients. AIR is designed to activate pre-positioned Trm cells at the earliest onset of symptoms, inducing a high-magnitude IFN-γ surge in the lung mucosa. By bridging the senescent “interferon gap” with the rapid effector kinetics of Trm activation, this approach represents a novel paradigm toward reconstituting youthful-like antiviral mucosal immunity to both enhance vaccine efficacy in the elderly and protect against both seasonal pathogens and emerging viral triggers (“Disease X”) of CRD. Future randomized studies in long-term care settings are planned to evaluate clinical outcomes in high-risk populations. Full article

Background/Objectives: Frailty is highly prevalent among individuals with chronic obstructive pulmonary disease (COPD) and further elevates the risk of disability, hospitalization, and mortality. However, longitudinal evidence examining the combined impact of COPD and frailty on adverse events remains limited. This study aims to examine the longitudinal association of COPD and frailty with adverse events. Methods: This longitudinal study analyzed data from the Toledo Study for Healthy Aging, including 1576 Spanish community-dwelling older adults (mean age 75 ± 6 years; 44% women). COPD was diagnosed according to GOLD criteria. Frailty was assessed using the Frailty Trait Scale-5 (FTS5), analyzed from both continuous and dichotomous perspectives. Multivariate proportional hazard regression models were used to assess mortality and hospitalization, and logistic regression was used for assessing worsening disability, adjusting for age, sex, and Charlson comorbidity index. Results: COPD was associated with an increased risk of hospitalization (HR: 1.43; 95%CI: 1.02–2.01; p = 0.04), but not mortality or disability. Frailty was independently associated with increased risk of mortality, hospitalization, and worsening disability (OR/HR ranging from 1.07 to 3.09; p < 0.001). Among individuals with COPD, frailty significantly increased the risk of mortality (HR: 5.51; 95%CI: 1.32–22.92; p = 0.019) and hospitalization (HR: 3.56; 95%CI: 1.42–8.92; p = 0.007). Compared with individuals without either frailty or COPD, the coexistence of COPD and frailty was associated with significantly higher risks of mortality and hospitalization, but not with worsening disability (p 0.069), whereas COPD alone (in non-frail individuals) was not associated with any adverse event. Conclusions: Frailty significantly increases the association of adverse outcomes, highlighting the importance of routinely assessing frailty in COPD population. Full article

The rapid evolution of structural heart interventions, particularly transcatheter aortic valve implantation (TAVI), transcatheter edge-to-edge repair (TEER), and hybrid procedures, has significantly expanded treatment options for elderly, frail, and multimorbid patients previously considered high risk or inoperable. However, perioperative risk stratification in this population remains challenging. Traditional risk scores such as EuroSCORE, EuroSCORE II, STS-PROM, CHA₂DS₂-VASc, and HAS-BLED were developed and validated primarily in cohorts undergoing conventional open-heart surgery (CABG and surgical valve replacement) more than 15–25 years ago. This narrative review critically evaluates the performance and limitations of these classical models in contemporary populations undergoing modern structural cardiac interventions. Evidence from registries and meta-analyses indicates only moderate discriminatory ability and systematic calibration errors. EuroSCORE II and STS-PROM frequently overestimate risk in low- and intermediate-risk patients while underestimating it in high-risk and frail individuals, particularly regarding neurological, renal complications, and prolonged hospitalization. Similar limitations apply to CHA₂DS₂-VASc and HAS-BLED when used beyond their original scope in the peri-procedural setting of TAVI/TEER. The review highlights the growing role of frailty assessment, procedure-specific variables, and machine learning algorithms, which demonstrate superior predictive performance compared to conventional scores. Until dedicated, regularly updated risk models based on large TAVI/TEER registries become available, traditional scores should be used only as supportive tools within multidisciplinary Heart Team discussions that incorporate individual frailty, quality of life, and patient preferences. Full article

Background/Objectives: Heat waves are increasingly frequent and intense climate events with significant implications for public health, particularly among frail older adults. While most evidence has focused on mortality and morbidity, healthcare service utilization represents an additional and potentially more sensitive indicator of heat-related health burden. Methods: A systematic review and meta-analysis was conducted following the PRISMA guidelines and prospectively registered in PROSPERO (CRD420251107598). PubMed/MEDLINE, Scopus, and Web of Science were searched up to August 2025. This study aimed to systematically review and quantitatively synthesize the evidence on the association between heat wave exposure and healthcare utilization—including hospitalizations, emergency department (ED) visits, and outpatient care—among frail older adults. Pooled effect estimates (RRs, IRRs, and ORs) were calculated using random-effects models. Heterogeneity was assessed using the I² statistic, and sensitivity analyses were performed by outcome type, effect measure, and risk of bias. Results: Fifty-five studies met the inclusion criteria. Heat wave exposure was consistently associated with increased healthcare utilization. Both hospitalizations and ED visits showed significant increases during heat wave periods, with results remaining robust across sensitivity analyses. Evidence on outpatient care was limited but suggested a similar pattern. Substantial heterogeneity was observed across studies, reflecting variability in exposure definitions, populations, and study designs. Overall, the methodological quality of the included studies was acceptable, with most presenting a low-to-moderate risk of bias. Conclusions: Heat waves are associated with increased healthcare utilization among frail older adults, indicating a relevant burden on healthcare systems. Healthcare utilization may represent a sensitive indicator of heat wave impact, complementing traditional clinical outcomes. Full article

Background/Objectives: Sarcopenia—the progressive loss of skeletal muscle mass and function—is a growing public health challenge in ageing populations. Island territories face compounded vulnerabilities due to distinct epidemiological and socio-economic profiles. This study examines sarcopenia risk prevalence among community-dwelling older adults in Tenerife (Canary Islands, Spain) and estimates the economic burden alongside the cost-effectiveness of evidence-based interventions. Methods: A cross-sectional study was conducted among 374 community-dwelling older adults (mean age 80.4 years, SD 4.8; 51.1% female) recruited from primary care health centres across three health zones in Tenerife. Participants were stratified into a control group without established chronic disease-related functional decline (Group 1; n = 274) and a case group with multimorbidity and functional limitations (Group 3; n = 100). Sarcopenia risk was assessed using the SARC-F questionnaire (threshold ≥ 4). A comprehensive geriatric battery—including the Barthel Index, FRAIL scale, MNA-SF, Pfeiffer test, SPPB, handgrip dynamometry, and IPAQ—characterised multidimensional vulnerability. Annual direct and indirect costs were estimated using unit costs from Spanish national health accounts, and intervention cost-effectiveness was modelled using published meta-analytic data. Results: Overall sarcopenia risk prevalence was 36.4% (n = 136; SARC-F ≥ 4), rising to 83.0% in the case group versus 19.3% in controls (OR ≈ 21.5, p < 0.001). Prevalence was 42.1% in males and 30.9% in females. Diabetes was independently associated with elevated risk (44.8% vs. 29.9%; OR 1.90, 95% CI 1.23–2.92; p = 0.003). Health Zone 1 exhibited the highest prevalence (63.0%) versus Zones 2 (23.5%) and 3 (32.8%). Multidimensional vulnerability was pervasive: 28.6% of participants were frail, 75.7% had nutritional compromise, 11.5% showed moderate cognitive impairment, and 89.8% reported low or no physical activity. The estimated annual socio-economic cost of sarcopenia in Tenerife is approximately EUR 88.9 million (Spain nationally: EUR 12.1 billion). Combined exercise–nutrition interventions yield cost-per-QALY ratios of EUR 3800–7000, far below Spain’s EUR 25,000/QALY threshold. Conclusions: Sarcopenia constitutes a major, multidimensionally compounded health burden in Tenerife’s older population, concentrated among frail, diabetic, nutritionally compromised, and physically inactive individuals. The economic case for universal SARC-F screening and multicomponent intervention is compelling, exceeding cost-effectiveness thresholds by a wide margin. Territorial disparities in burden call for equity-oriented, place-based resource allocation within the Canarian health system. Full article

Frail older adults face an increased risk and severity of sepsis, which contributes to a notably high mortality rate. The management of sepsis in this population presents significant challenges, such as diagnostic complexity, a higher prevalence of multidrug-resistant pathogens, difficulties in achieving effective source control, and an increased risk of adverse events and toxicity associated with antibiotic therapy. In addition, accurate prognostic evaluation based on a comprehensive geriatric assessment is essential to determine the intensity of care required and to develop a personalized plan of care. Despite these considerations, frail older adults are still often underrepresented in randomized clinical trials and guidelines. In this narrative review, we discuss the main pillars of tailored antimicrobial stewardship in frail older adults. We propose a practical, stepwise approach to individualized care, delivered by a multidisciplinary team and based on a careful balance between treatment intensity and patients’ vulnerabilities, needs, and priorities. Full article

Background: Implant-related infection following femoral fracture surgery is a severe complication in elderly patients and is associated with high morbidity and mortality. Most available evidence on periprosthetic joint infection (PJI) derives from elective arthroplasty populations, which differ substantially from patients undergoing surgery for femoral fractures. This study aimed to investigate the microbiological profile and clinical characteristics of implant-related infections after proximal femoral fracture surgery. Materials and Methods: A retrospective observational study was conducted on 20 patients aged ≥70 years who developed implant-related infection after surgical treatment of proximal femoral fractures between 2020 and 2025 at a referral trauma center. Surgical procedures included intramedullary nailing, hemiarthroplasty, and total hip arthroplasty. Only patients with Charlson Comorbidity Index ≥ 4 and infection occurring within one year of the index surgery were included. Clinical, surgical, microbiological, and antibiotic therapy data were retrospectively reviewed. Results: The cohort had a mean age of 82.4 years and a high comorbidity burden (mean Charlson index 4.8). The most frequently isolated pathogen was Staphylococcus aureus (25.9%), with 85% methicillin-resistant strains. Other pathogens included Enterococcus faecalis, Klebsiella pneumoniae, and Escherichia coli. Polymicrobial infections were observed in 25% of patients. One-year mortality was 25%. Conclusions: Implant-related infections after femoral fracture surgery represent a distinct clinical entity compared with elective PJI, characterized by frail patients and a higher prevalence of multidrug-resistant organisms. These findings highlight the need for tailored preventive and therapeutic strategies in this high-risk population. Full article

Background: Radical cystectomy (RC) remains associated with substantial perioperative morbidity despite advances in minimally invasive surgery and reconstructive techniques. Comparisons between intracorporeal reconstruction, robotic-assisted approaches, and urinary diversion strategies are frequently confounded by clinical heterogeneity and patient selection. This study aimed to perform a stratified surgical systematic review evaluating perioperative outcomes across distinct reconstructive pathways following RC. Methods: A PRISMA-guided systematic review identified comparative studies evaluating intracorporeal versus extracorporeal/open orthotopic neobladder reconstruction, robotic-assisted versus open radical cystectomy in frail patients undergoing ureterocutaneostomy, and ileal conduit versus orthotopic urinary diversion. Analyses were performed within predefined clinical modules to preserve surgical context. Outcomes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs), complemented by rare-event sensitivity analyses and exploratory absolute risk metrics, including number needed to treat or harm (NNT/NNH). Continuous outcomes such as estimated blood loss and length of hospital stay were assessed descriptively. Results: Three comparative observational cohorts met inclusion criteria. Intracorporeal neobladder reconstruction and robotic-assisted cystectomy demonstrated consistent reductions in transfusion rates and favourable trends in perioperative morbidity. In frail patient populations, robotic surgery showed reduced intraoperative burden without increased readmission or mortality. Ileal conduit diversion was associated with increased wound-related complications and infectious outcomes; however, these findings likely reflect baseline differences in patient frailty and selection. Rare-event sensitivity analyses confirmed directional consistency of treatment effects despite wide confidence intervals. Integration of absolute risk differences and NNT/NNH metrics provided clinically interpretable context for stratified outcomes. Conclusions: Minimally invasive and intracorporeal strategies following radical cystectomy may reduce perioperative burden, whereas diversion type primarily influences complication patterns rather than overall morbidity. A stratified analytical framework integrating relative and absolute effect measures may offer a more clinically meaningful approach to evaluating reconstructive strategies in heterogeneous surgical populations. Full article

Background/Objectives: Chronic subdural hematoma (cSDH) is an increasingly prevalent neurosurgical condition in the aging population. Burr hole craniotomy (BHC) with irrigation and postoperative drainage represents the evidence-based standard of care, yet recurrence rates remain substantial. Twist drill craniostomy (TDC), a minimally invasive bedside procedure performed under local anesthesia, offers theoretical advantages for frail patients but has been largely abandoned due to concerns regarding incomplete evacuation and recurrence. This study aimed to identify the predictors of a successful TDC outcome and to compare the recurrence rates between TDC and BHC. Methods: We performed a retrospective cohort study of consecutive patients undergoing surgical treatment for radiologically confirmed cSDH at RWTH Aachen University Hospital between 2015 and 2023. Hematoma morphology was classified using an extended CT-based architecture system and grouped into homogeneous, organized, sedimented, or subacute categories. The primary endpoint was recurrence requiring surgical reintervention. Multivariable logistic regression was used to identify independent predictors of recurrence among patients discharged after definitive TDC. Propensity score matching was performed to compare recurrence rates between TDC and BHC while adjusting for baseline demographic, clinical, and radiographic differences. Results: Among 178 patients initially treated with TDC, 56 (31.5%) were discharged without conversion to BHC. Late recurrence occurred in 26 of 56 patients (46.4%) treated definitively with TDC. In multivariable analysis, homogeneous hematoma architecture was the only independent predictor of recurrence (adjusted OR 4.48, 95% CI 1.10–22.07, p = 0.037). Propensity score matching yielded 48 well-balanced pairs of TDC and BHC patients. Recurrence rates remained significantly higher after TDC compared with BHC (42.6% vs. 17.0%, p = 0.012), as confirmed by conditional logistic regression (adjusted OR 3.20, 95% CI 1.17–8.73). Conclusions: Twist drill craniostomy may provide definitive treatment in carefully selected patients but is associated with substantially higher recurrence rates than burr hole craniotomy, particularly in homogeneous hematomas. Burr hole evacuation remains the preferred standard approach, while optimized drainage protocols and architecture-guided selection may define a limited role for TDC in high-risk patients. Full article

Background and Objectives: Breast cancer surgery is increasingly performed in older patients with multimorbidity, in whom cardiovascular disease and frailty may substantially modify perioperative risk, including vulnerability to heart failure decompensation and other major medical complications. However, most available studies report global perioperative complication rates and composite medical endpoints, with heart failure events only rarely captured as dedicated outcomes, and operative technique, cardiovascular comorbidity, and frailty are often treated as separate domains rather than components of an integrated risk framework. Materials and Methods: We conducted a systematized narrative review with a structured literature search in PubMed/MEDLINE, Scopus, and Web of Science from inception to 31 January 2026, including original studies of adult patients undergoing breast-conserving surgery, mastectomy, and/or reconstruction that reported early postoperative outcomes in relation to comorbidities, cardiovascular risk, or frailty. Eligibility assessment, data extraction, and qualitative synthesis followed key PRISMA 2020 principles, and findings were organized into three prespecified domains: surgical complexity, cardiovascular vulnerability (including patients with heart failure where reported), and frailty. Results: Nineteen studies (retrospective cohorts, registry-based analyses, and large database studies, primarily ACS NSQIP) met inclusion criteria, encompassing diverse breast surgery populations, including elderly, metastatic, and reconstructive cohorts. Across datasets, escalation from breast-conserving surgery to mastectomy and then to increasingly complex reconstruction was associated with a stepwise increase in perioperative complications, reoperations, bleeding, and, in selected series, catastrophic events. Preexisting cardiovascular disease and systemic vascular pathology significantly amplified postoperative morbidity even in procedures considered low or intermediate cardiac risk, with signals that patients with underlying heart failure carry particularly heightened vulnerability, although HF-specific events were infrequently reported as separate endpoints. Frailty, mainly assessed using modified frailty indices, consistently emerged as a strong, age-independent predictor of 30-day complications, mortality, and readmissions across surgical types, including both breast-conserving and reconstructive procedures. Conclusions: Early postoperative outcomes after breast cancer surgery are associated with the interaction between surgical complexity, cardiovascular comorbidity (with limited HF-specific reporting), and frailty rather than by operative technique alone. In this context, our synthesis primarily reflects overall cardiovascular vulnerability in comorbid and frail patients, with heart failure risk inferred indirectly from the available data. These findings support a patient-centered, risk-adapted surgical strategy in which the extent and timing of surgery and reconstruction are tailored to each patient’s cardiovascular profile and frailty status, with preferential use of breast-conserving or less complex procedures in vulnerable individuals. Integrating standardized frailty assessment and cardio-oncologic evaluation into preoperative workflows, and prospectively validating this tri-axial framework in dedicated cohorts, may improve perioperative risk stratification and reduce the burden of postoperative medical complications in an aging breast cancer population. Full article

The progressive aging of the atrial fibrillation (AF) population, frequently characterized by high ischemic and bleeding risks, has led to a substantial increase in referrals for left atrial appendage occlusion (LAAO). The expansion of indications and the high procedural success rate of LAAO have further contributed to rising procedural volumes. However, this growth introduces important challenges: LAAO candidates are often elderly and frail, with increased anesthesia-related risks, and high-volume catheterization laboratories may face logistical constraints, particularly in centers without dedicated anesthesiology support. The current gold standard approach, transesophageal echocardiography (TEE) under general anesthesia (GA), ensures optimal imaging and procedural control but may increase procedural complexity and perioperative risks. In response, minimalist strategies are increasingly explored, targeting either the anesthetic protocol or the imaging modality. Conscious sedation (CS) protocols have been adopted to reduce anesthesia-related burden while maintaining TEE guidance. Alternatively, imaging-based strategies aim to replace TEE with less invasive modalities, including intracardiac echocardiography (ICE), transesophageal–intracardiac echocardiography (TE-ICE), and MicroTEE. Each approach presents specific advantages and limitations regarding safety, feasibility, operator expertise, and institutional resources. Taken together, these findings support a patient-centered approach to LAAO, whether traditional or minimalist, in which the choice of anesthetic strategy and echocardiographic guidance is driven by institutional resources, operator expertise, and individual patient characteristics rather than by expected differences in procedural or clinical efficacy. This review summarizes current evidence on minimalist LAAO pathways and discusses their role in achieving a tailored, resource-conscious procedural model. Full article