Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
J Am Coll Cardiol. 2014 Mar 4;63(8):747-62. doi: 10.1016/j.jacc.2013.09.070. Epub 2013 Nov 27.
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.
由于患者的老龄化和日益复杂，衰弱已成为心血管医学的一个优先主题。尽管人们认识到衰弱是评估患有心血管疾病（CVD）的老年人的关键因素，但尚未制定路线图来促进其在常规临床实践中的应用。因此，我们试图综合现有证据，并就如何将衰弱纳入临床实践提供一些看法。衰弱是一种反映生理储备减少和对压力源脆弱性的生物综合征。已经开发了 20 多种衰弱评估工具，其中大多数工具都围绕着衰弱的核心表型领域展开，即身体表现测试和问卷测量的衰弱——缓慢的步行速度、虚弱、不活动、疲惫和消瘦。衰弱的患病率在 10%到 60%之间不等，具体取决于 CVD 的负担，以及用于定义衰弱的工具和截止值。流行病学研究一致表明，在稳定的 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一系列范围内，衰弱使死亡率和发病率的相对风险增加了 2 倍以上。衰弱为现有的风险模型提供了有价值的预后信息，并帮助临床医生为患者定义最佳的护理途径。旨在改善患有 CVD 的衰弱老年人预后的干预措施，如多学科心脏康复，正在积极进行测试。最终，衰弱不应被视为拒绝治疗的理由，而应被视为以更以患者为中心的方式提供治疗的手段。
