The problem addressed by the Statement is straightforward: evaluating the heart and vasculature alone is not enough in older adults with cardiovascular disease. Cognitive impairment, frailty, and physical functional decline are closely interconnected and can influence not only clinical outcomes but also treatment tolerance and the ability to remain independent.

Viewing cardiovascular disease in the context of biological aging

The ACC explains that cardiovascular disease, cognitive impairment, and frailty should be understood not simply as separate conditions, but as manifestations of shared biological aging processes.

Cardiovascular risk factors such as hypertension, diabetes, obesity, and hyperlipidemia are also linked to the risks of cognitive decline and frailty. Inflammation, vascular dysfunction, arterial stiffness, and loss of muscle function can affect multiple organ systems at the same time.

For older adults, cardiovascular care therefore needs to extend beyond blood pressure and cardiac function to include how well a person can move and maintain independence.

Frailty screening has become a cardiovascular care issue

The Statement calls for routine, feasible screening for cognitive impairment and frailty in older adults with cardiovascular disease, including in outpatient settings and after hospitalization.

This moves frailty beyond the traditional boundaries of geriatrics and rehabilitation and places it within cardiovascular care. Two patients with the same cardiovascular diagnosis may have very different recovery trajectories depending on their physiological reserve and functional status.

This is also why the ACC emphasizes outcomes such as mobility, independence, and physical function alongside traditional cardiovascular endpoints.

SPPB is presented as a direct physical performance assessment

One of the most relevant sections of the Statement concerns direct assessment of physical function.

The ACC presents grip strength, gait speed, and the Short Physical Performance Battery (SPPB) as examples of direct physical assessment methods. The SPPB includes standing balance in three positions, a 3- or 4-meter walk, and five chair rises performed with the arms folded.

The authors note that these direct physical assessments can help predict physical frailty, falls, and dependence.

The SPPB itself is not new. What is notable is that an official ACC Scientific Statement addressing older adults with cardiovascular disease includes the SPPB among clinically relevant direct measures of physical function.

The real challenge is the clinical workflow

The Statement does not stop at identifying useful assessments.

The authors also note that even relatively brief physical performance measures may be difficult to incorporate into a cardiology or internal medicine visit. Clinical encounters already involve many competing tasks, while physical testing requires space, staff time, standardized administration, measurement, and documentation.

The Statement therefore highlights the need for pragmatic screening strategies that are feasible in high-volume practice settings and can overcome workflow and resource barriers.

The key question is no longer simply, “Should frailty be assessed?”

It is, “How can frailty be assessed consistently as part of routine cardiovascular care?”

Function itself is an important outcome in older cardiovascular patients

The Statement also challenges the traditional emphasis of cardiovascular research on major cardiovascular events such as death, myocardial infarction, and stroke.

For many older adults, other outcomes are equally important: being able to walk, returning to independent living after hospitalization, and maintaining the ability to perform daily activities.

The authors point out that measures of physical performance and daily function are often absent or nonstandardized in clinical trials. They argue for more systematic incorporation of functional outcomes into both clinical care and research involving older adults with cardiovascular disease.

Functional recovery is also central to cardiac rehabilitation

This perspective connects directly with cardiac rehabilitation.

In discussing resilience in older adults with cardiovascular disease, the Statement describes fundamental domains such as gait, muscle strength, balance, and endurance as closely related to the ability to recover independence after illness or hospitalization.

Cardiac rehabilitation is likewise evolving beyond aerobic exercise alone toward multidomain approaches that include strength, balance, mobility, nutrition, and other health needs.

Repeated, standardized measurement of functional status before and after treatment or rehabilitation may therefore serve not only as screening but also as a way to follow recovery and treatment response.

The implementation gap identified by the ACC authors

The final sections of the Statement describe the remaining gap clearly.

There is currently no consensus on a “standardized and clinically feasible approach to frailty assessment” that can be efficiently integrated into cardiovascular care workflows.

The authors also identify practical questions that remain unresolved: how screening should fit within cardiology workflows, who should perform it, and what thresholds should trigger further evaluation or referral.

The problem, then, is not the absence of clinically meaningful assessments. The implementation challenge is how to make them brief, consistent, repeatable, and practical in busy clinical settings.

A potential role for automated SPPB

AndanteFit is an automated system designed to measure and score the three components of the SPPB—balance, gait speed, and the five-times chair stand—using an instrumented, standardized process. It is designed to reduce manual timing and documentation and to complete an SPPB assessment in approximately three minutes.

The value of automation is not simply speed. It also enables the same protocol to be administered across different operators and sites and allows repeated assessments to be collected in a consistent format.

The central challenge raised by the ACC Statement is not the creation of another concept of frailty. It is how to integrate clinically meaningful physical function assessment into real cardiovascular care and research workflows.

From that perspective, we believe that an automated SPPB system such as AndanteFit may help address the concerns raised by the ACC authors regarding time, standardization, staffing, and workflow, and may help make physical function assessment more practical in routine cardiovascular care.