Cardiac surgery in the elderly: What goals of care?
Cardiac surgery in the elderly: What goals of care?
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DOI：
10.4081/monaldi.2017.852
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发表时间：
2017-01-01
影响因子：
1.9
通讯作者：
Baldasseroni, Samuele
中科院分区：
文献类型：
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作者：
Pratesi, Alessandra;Orso, Francesco;Baldasseroni, Samuele
目前，大多数心脏外科介入治疗已在老年人中成功实施，短期死亡率和发病率均较低;然而，必须强调的是，我们在预测残疾等长期结果方面的能力存在重大困难，生活质量恶化和功能丧失。原因可能在于目前的心脏手术风险评分无法捕获术前虚弱表型，因此我们无法勾勒出重要的以患者为中心的结局（如无残疾生存率）的术后轨迹。从这个角度来看，不止一份老年医学声明强调了心血管试验中患者报告结局的系统性使用不足，即使考虑到其与老年人感觉和愿望的相关性。因此，在未来，老年心脏病学社区必须通过计划试验来缩小这一证据差距，在这些试验中，以患者为中心的结局被视为治疗和心血管治疗的主要目标。
At present, the majority of cardiac surgery interventions have been performed in the elderly with successful short-term mortality and morbidity; however significant difficulties must be underlined about our capacity to predict long-term outcomes such as disability, worsening quality of life and loss of functional capacity.The reason probably resides on inability to capture preoperative frailty phenotype with current cardiac surgery risk scores and consequently we are unable to outline the postoperative trajectory of an important patients' centered outcome such as disability free survival. In this perspective, more than one geriatric statement have stressed the systematic underuse of patient reported outcomes in cardiovascular trials even after taking account of their relevance to older feel and wishes. Thus, in the next future is mandatory for geriatric cardiology community closes this gap of evidences through planning of trials in which patients' centered outcomes are considered as primary goals of therapies as well as cardiovascular ones.