Frailty assessment in the cardiovascular care of older adults.
Frailty assessment in the cardiovascular care of older adults.
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DOI：
10.1016/j.jacc.2013.09.070
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发表时间：
2014-03-04
影响因子：
24
通讯作者：
Forman DE
中科院分区：
文献类型：
--
作者：
Afilalo J;Alexander KP;Mack MJ;Maurer MS;Green P;Allen LA;Popma JJ;Ferrucci L;Forman DE
由于我们患者的老龄化和日益复杂的性质，虚弱已成为心血管医学的一个高度优先主题。尽管认识到虚弱是评估老年心血管疾病（CVD）的关键因素，但尚未制定路线图以促进其在常规临床实践中的采用。因此，我们试图综合现有的证据，并提供一个关于如何将脆弱性纳入临床实践的观点。虚弱是一种生物综合征，反映了一种生理储备减少和易受压力的状态。已经开发了20多种虚弱评估工具，其中大多数工具都围绕着虚弱的核心表型领域--缓慢的行走速度、虚弱、不活动、疲惫和萎缩--通过身体表现测试和问卷调查来测量。虚弱的患病率范围为10%至60%，取决于CVD负担以及定义虚弱的工具和截止值。流行病学研究一致表明，在稳定性CVD、急性冠状动脉综合征、心力衰竭以及手术和经导管介入治疗的范围内，虚弱的死亡率和发病率的相对风险> 2。Frailty为现有风险模型提供了有价值的预后见解，并协助临床医生为患者定义最佳护理途径。正在积极测试旨在改善患有心血管疾病的体弱老年人结局的干预措施，如多学科心脏康复。最终，虚弱不应被视为拒绝护理的理由，而应被视为以更以患者为中心的方式提供护理的一种手段。
Due to the aging and increasingly complex nature of our patients, frailty has become a high-priority theme in cardiovascular medicine. Despite the recognition of frailty as a pivotal element in the evaluation of older adults with cardiovascular disease (CVD), there has yet to be a road map to facilitate its adoption in routine clinical practice. Thus, we sought to synthesize the existing body of evidence and offer a perspective on how to integrate frailty into clinical practice. Frailty is a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors. Upward of 20 frailty assessment tools have been developed, with most tools revolving around the core phenotypic domains of frailty—slow walking speed, weakness, inactivity, exhaustion, and shrinking—as measured by physical performance tests and questionnaires. The prevalence of frailty ranges from 10% to 60%, depending on the CVD burden, as well as the tool and cutoff chosen to define frailty. Epidemiological studies have consistently demonstrated that frailty carries a relative risk of >2 for mortality and morbidity across a spectrum of stable CVD, acute coronary syndromes, heart failure, and surgical and transcatheter interventions. Frailty contributes valuable prognostic insights incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients. Interventions designed to improve outcomes in frail elders with CVD such as multidisciplinary cardiac rehabilitation are being actively tested. Ultimately, frailty should not be viewed as a reason to withhold care but rather as a means of delivering it in a more patient-centered fashion.