Role of Frailty in Patients With Cardiovascular Disease
Role of Frailty in Patients With Cardiovascular Disease
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DOI：
10.1016/j.amjcard.2009.01.375
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发表时间：
2009-06-01
影响因子：
2.8
通讯作者：
Bergman, Howard
中科院分区：
文献类型：
--
作者：
Afilalo, Jonathan;Karunananthan, Sathya;Bergman, Howard
虚弱是一种老年综合征，易受应激因素的影响，是心血管疾病（CVD）患者的致病和预后因素。美国心脏协会和老年心脏病学会呼吁更好地了解虚弱，因为它涉及老年人的心脏护理。本研究的目的是系统地回顾有关心血管疾病患者虚弱的研究。检索了奥维德MEDLINE、EMBASE、科克伦数据库和未发表的来源。入选标准是使用系统定义的标准评估虚弱程度，以及研究人群患有流行或偶发CVD。纳入了9项研究，包括54，250例老年患者，平均加权随访时间为6.2年。在社区居住的老年人中，CVD与普遍虚弱的比值比（OR）为2.7至4.0，基线时不虚弱的人中偶发虚弱的OR为1.5，步态速度（虚弱的测量）与偶发CVD的OR为1.6相关。在有记录的严重冠状动脉疾病或心力衰竭的老年患者中，虚弱的患病率为50%至54%，调整潜在混杂因素后，这与全因死亡率的OR为1.6至4.0相关。总之，虚弱和心血管疾病之间存在联系;虚弱可能导致心血管疾病，就像心血管疾病可能导致虚弱一样。虚弱的存在使死亡率逐渐增加。虚弱评估在临床实践中的作用可能是改善心血管风险的估计，这在异质性老年患者人群中往往不太准确。(C)2009 Elsevier Inc. (Am J Cardiol 2009;103：1616-1621）
Frailty is a geriatric syndrome of increased vulnerability to stressors that has been implicated as a causative and prognostic factor in patients with cardiovascular disease (CVD). The American Heart Association and the Society of Geriatric Cardiology have called for a better understanding of frailty as it pertains to cardiac care in the elderly. The aim of this study was to systematically review studies of frailty in patients with CVD. A search was conducted of Ovid MEDLINE, EMBASE, the Cochrane Database, and unpublished sources. Inclusion criteria were an assessment of frailty using systematically defined criteria and a study population with prevalent or incident CVD. Nine studies were included, encompassing 54,250 elderly patients with a mean weighted follow-up of 6.2 years. In community-dwelling elders, CVD was associated with an odds ratio (OR) of 2.7 to 4.0 for prevalent frailty and an OR of 1.5 for incident frailty in those who were not frail at baseline, Gait velocity (a measure of frailty) was associated with an OR of 1.6 for incident CVD. In elderly patients with documented severe coronary artery disease or heart failure, the prevalence of frailty was 50% to 54%, and this was associated with an OR of 1.6 to 4.0-for all-cause mortality after adjusting for potential confounders. In conclusion, there exists a relation between frailty and CVD; frailty may lead to CVD, just as CVD may lead to frailty. The presence of frailty confers an incremental increase in mortality. The role of frailty assessment in clinical practice may be to refine estimates of cardiovascular risk, which tend to be less accurate in the heterogenous elderly patient population. (C) 2009 Elsevier Inc. (Am J Cardiol 2009;103:1616-1621)