The 2026 European Society of Cardiology guidelines for cardiovascular disease and chronic kidney disease offer a robust organ-centric framework but systematically underweight geriatric complexity. This editorial introduces STAMP-F — an unvalidated conceptual extension adding Frailty, Function, and Future Healthspan to conventional cardiorenal risk metrics — arguing that Clinical Frailty Scale scores and gait speed measurements could serve as pragmatic entry points for individualized treatment decisions in older adults.
The core tension this piece illuminates is clinically real and underappreciated: current cardiorenal guidelines optimize for surrogate endpoints — albuminuria, GFR trajectories, ejection fraction — while older patients frequently prioritize mobility, cognition, and independence. This mismatch isn't new to geriatric medicine, but its explicit articulation within cardiology guideline commentary represents meaningful progress. The frailty-polypharmacy interaction is particularly important: SGLT2 inhibitors, RAASi combinations, and diuretics that confer organ-protective benefits in robust older adults can precipitate falls, acute kidney injury, and dehydration in frail phenotypes, fundamentally shifting the benefit-risk calculus.
Critical limitations are substantial, however. This is a single-author editorial from a single-center affiliation, STAMP-F is explicitly unvalidated, and no outcome data are presented. The proposal remains conceptual architecture rather than clinical evidence. Its value lies in prompting geriatric-cardiology collaboration and framing prospective trial questions — incremental, not paradigm-shifting, but pointing toward a necessary evolution in how cardiology guidelines address phenotypic aging.
