Orkaby Ariela R, Forman Daniel E
Division of Cardiology, VA Boston Healthcare System, 400 Veterans of Foreign Wars Pkwy, West Roxbury, MA 02132, USA; Division of Aging, Brigham & Women's Hospital, 1620 Tremont Street, Boston, MA 02120, USA.
Section of Geriatric Cardiology, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA 15213, USA; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University Dr C, Pittsburgh, PA 15240, USA.
Clin Geriatr Med. 2016 May;32(2):359-71. doi: 10.1016/j.cger.2016.01.004. Epub 2016 Feb 12.
Age-related cardiovascular disease in older adults is more likely to occur in combination with other age-related diseases, with mounting interactive complexity as multiple morbidities accumulate. Although invasive cardiac procedures are frequently recommended for cardiovascular disease, their value is less certain in the context of age-related intricacies of care. Tools for risk assessment before invasive procedures are insensitive to risks corresponding to the unique challenges of older adults. Recognizing multimorbidity and other age-related risks provides opportunities to intervene and moderate dangers. By refocusing risk assessment in terms of patient-centered goals, the fundamental utility of invasive cardiac procedures may be reconsidered and alternative therapies prioritized.
老年人中与年龄相关的心血管疾病更有可能与其他与年龄相关的疾病合并发生，随着多种疾病的累积，相互作用的复杂性日益增加。尽管对于心血管疾病经常推荐采用侵入性心脏手术，但在与年龄相关的复杂护理背景下，其价值尚不确定。侵入性手术前的风险评估工具对与老年人独特挑战相对应的风险不敏感。认识到多种疾病并存以及其他与年龄相关的风险为干预和降低危险提供了机会。通过以患者为中心的目标重新调整风险评估，可能会重新考虑侵入性心脏手术的基本效用，并优先考虑替代疗法。
