Table 3. Proposals for daily clinical implications of frailty assessment in older ACS patients.

Why	When	How	Data
To guide invasive strategy	At hospital admission	Scales based on interview or chart review (i.e., FRAIL scale, CFS, EFS, Frailty Index, SHARE-FI)	No RCT. Invasive strategy is related to better outcomes in older ACS patients, but in frail subjects there could be a lack of benefit.
To improve risk stratification	At hospital admission At hospital discharge	Scales based on interview or chart review (i.e., FRAIL scale) Scales including physical performance assessment ( i.e., SPPB, Green score)	No RCT. FRAIL scale and Green score showed to have important predictive value, outperforming GRACE score alone.
To guide complete revascularization	Before hospital discharge	Scales based on interview or chart review ( i.e., CFS, EFS, Frailty Index, FRAIL scale). Scales including physical performance assessment ( i.e., Fried score, SHARE-FI, gait speed, SPPB).	Ongoing RCT. Age and multivessel disease emerged as independent predictor of ischemic events; ischemic events could be related to the fact that only few patients with a multivessel disease receive a complete revascularization.
To guide DAPT lenght	At hospital discharge	Scales based on interview or chart review. Scales including physical performance assessment (i.e., gait speed, SPPB).	No RCT. Age is related to high bleeding risk but also to high ischemic risk; no data about frailty implications.
To improve physical performance	At hospital discharge	Scales including physical performance assessment ( i.e., gait speed, handgrip strength, SPPB).	Ongoing RCT. Low physical performance is related to poor prognosis in older patients with cardiovascular diseases.
To improve nutritional status	At hospital discharge	Scales based on interview or chart review ( i.e., FRAIL scale, EFS). Scales including physical performance and nutritional status assessment (Fried score, SPPB, gait speed, handgrip strength, SHARE-FI, Green score).	No RCT. Vitamin supplementation could prevent sarcopenia and improve older adults' prognosis.

CFS: clinical frailty score; DAPT: dual antiplatelet therapy; EFS: Edmonton frailty scale; GRACE: Global risk of adverse cardiac events; RCT: randomized clinical trials; SHARE-FI: Survey of Health, Ageing and Retirement in Europe Frailty Instrument; SPPB: short physical performance battery.