Primary Care Department, Azienda USL Toscana Sud Est, AFT Orbetello, Grosseto, Italy.
Department of Cardiology, University Hospital Jean Minjoz, and EA3920, University of Franche-Comté, 25000, Besançon, France.
Adv Exp Med Biol. 2020;1216:87-97. doi: 10.1007/978-3-030-33330-0_10.
Frailty and cardiovascular disease (CVD) are both highly prevalent in older adults. Cardiovascular disease has been identified as the most frequent cause of death, while frailty has been identified as one of geriatric giants characterized by decreased physiological reserves and increased vulnerability. However, the exact pathobiological links between the two conditions have not been fully elucidated. Consequently, we observe a relevant difficulty not only in accurately defining cardiovascular risk in vulnerable elderly patients (and the other way around), but also a lack of consensus regarding CVD management in the very old. Nowadays, considering the enormous technical innovation, many elderly patients, if appropriately selected, could be eligible even for the most complex treatments, including invasive cardiological procedures. Identification of frail patients at risk of negative outcomes can allow the customization of therapeutic interventions in elderly patients with CVD, allowing the elderly who can benefit from them to undergo even invasive procedures and avoiding futile or dangerous treatments for the most vulnerable patients. A large number of tools and definitions for assessing frailty have been proposed; different scales and assessment tools can be useful for different purposes, but at present there is no clear indication for their use in CVD. In this chapter, we will describe the main geriatric approach to ascertain frailty, the assessment tools used in patients with cardiovascular diseases, and propose an operational strategy to evaluate frailty and identify patients eligible for pharmacologic or surgical interventions.
虚弱和心血管疾病（CVD）在老年人中都非常普遍。心血管疾病已被确定为最常见的死亡原因，而虚弱已被确定为以生理储备减少和易感性增加为特征的老年病巨人之一。然而，这两种情况之间的确切病理生物学联系尚未完全阐明。因此，我们不仅在准确定义脆弱老年患者的心血管风险（反之亦然）方面存在相关困难，而且在非常老年患者的 CVD 管理方面也缺乏共识。如今，考虑到巨大的技术创新，许多如果经过适当选择的老年患者，即使符合最复杂的治疗方案，包括侵入性心脏病学程序，也有资格接受治疗。识别有发生不良后果风险的虚弱患者，可以使患有 CVD 的老年患者的治疗干预措施个性化，使那些可以从中受益的老年人能够接受即使是侵入性的程序，同时避免对最脆弱的患者进行无用或危险的治疗。已经提出了许多用于评估虚弱的工具和定义；不同的量表和评估工具可能对不同的目的有用，但目前在 CVD 中没有明确的使用指征。在本章中，我们将描述确定虚弱的主要老年病学方法、用于心血管疾病患者的评估工具，并提出一种评估虚弱和识别有资格接受药物或手术干预的患者的操作策略。
