Joseph Susan M, Manghelli Joshua L, Vader Justin M, Keeney Tamra, Novak Eric L, Felius Joost, Martinez Sara C, Nassif Michael E, Lima Brian, Silvestry Scott C, Rich Michael W
Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas; Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas.
Department of Surgery, Indiana University, Indianapolis, Indiana.
Am J Cardiol. 2017 Oct 15;120(8):1349-1354. doi: 10.1016/j.amjcard.2017.07.074. Epub 2017 Aug 1.
Frail patients are more prone to adverse events after cardiac surgery, particularly after implantation of left ventricular assist devices. Thus, frailty assessment may help identify patients unlikely to benefit from left ventricular assist device therapy. The purpose was to establish a suitable measure of frailty in adults with end-stage heart failure. In a prospective cohort of 75 patients (age 58 ± 12 years) with end-stage heart failure, we assessed the association between frailty (5-component Fried criteria) and the composite primary outcome of inpatient mortality or prolonged length of stay, as well as extubation status, time on ventilator, discharge status, and long-term mortality. Fried frailty criteria were met in 44 (59%) patients, but there was no association with the primary outcome (p = 0.10). However, an abridged set of 3 criteria (exhaustion, inactivity, and grip strength) was predictive of the primary outcome (odds ratio 2.9, 95% confidence interval 1.1 to 7.4), and of time to extubation and time to discharge. In patients with advanced heart failure, the 5-component Fried criteria may not be optimally sensitive to clinical differences. In conclusion, an abridged set of 3 frailty criteria was predictive of the primary outcome and several secondary outcomes, and may therefore be a clinically useful tool in this population.
虚弱患者在心脏手术后更容易发生不良事件，尤其是在植入左心室辅助装置后。因此，虚弱评估可能有助于识别不太可能从左心室辅助装置治疗中获益的患者。目的是建立一种适用于终末期心力衰竭成人患者的虚弱测量方法。在一个由75例（年龄58±12岁）终末期心力衰竭患者组成的前瞻性队列中，我们评估了虚弱（5项Fried标准）与住院死亡率或住院时间延长的复合主要结局之间的关联，以及拔管状态、呼吸机使用时间、出院状态和长期死亡率。44例（59%）患者符合Fried虚弱标准，但与主要结局无关联（p = 0.10）。然而，一套简化的3项标准（疲惫、活动减少和握力）可预测主要结局（比值比2.9，95%置信区间1.1至7.4），以及拔管时间和出院时间。在晚期心力衰竭患者中，5项Fried标准可能对临床差异的敏感性欠佳。总之，一套简化的3项虚弱标准可预测主要结局和几个次要结局，因此可能是该人群中一种有用的临床工具。
