Beltrami Matteo, Fumagalli Carlo, Milli Massimo
Cardiology Unit, San Giovanni di Dio Hospital, Florence 50142, Italy.
Cardiomyopathy Unit, Careggi University Hospital, Florence 50139, Italy.
World J Cardiol. 2021 Jan 26;13(1):1-10. doi: 10.4330/wjc.v13.i1.1.
Heart Failure (HF) in elderly patients is a systemic syndrome where advanced age, comorbidities with organ system deterioration, frailty and impaired cognition significantly impact outcome. Cardiac cachexia, sarcopenia and frailty despite overlap in definitions are different clinical entities that frequently coexist in HF patients. However, these co-factors often remain unaddressed, resulting in poor quality-of-life, prolonged physical disability and exercise intolerance and finally with higher rehospitalization rates and mortality. Strategy aim to increase muscle mass and muscle strength and delay the occurrence of frailty state appear essential in this regard. Common HF drugs therapy (b-blockers, angiotensin-converting enzyme inhibitors) and prescription of physical exercise program remain the cornerstone of therapeutic approach in HF patients with new promising data regarding nutritional supplementation. However, the treatment of all these conditions still remain debated and only a profound knowledge of the specific mechanisms and patterns of disease progression will allow to use the appropriate therapy in a given clinical setting. For all these reasons we briefly review current knowledge on frailty, sarcopenia and cachexia in HF patients with the attempt to define clinically significant degrees of multiorgan dysfunction, specific "red alert" thresholds in clinical practice and therapeutic approach.
老年患者的心力衰竭（HF）是一种全身性综合征，高龄、伴有器官系统功能衰退的合并症、身体虚弱和认知功能受损都会对其预后产生重大影响。尽管在定义上存在重叠，但心脏恶病质、肌肉减少症和身体虚弱是不同的临床实体，在HF患者中经常并存。然而，这些共同因素往往未得到解决，导致生活质量低下、身体残疾时间延长和运动不耐受，最终导致再住院率和死亡率升高。在这方面，旨在增加肌肉量和肌肉力量并延缓身体虚弱状态出现的策略似乎至关重要。常见的HF药物治疗（β受体阻滞剂、血管紧张素转换酶抑制剂）和体育锻炼计划的制定仍然是HF患者治疗方法的基石，关于营养补充剂也有了新的有前景的数据。然而，所有这些病症的治疗仍存在争议，只有深入了解疾病进展的具体机制和模式，才能在特定的临床环境中使用适当的治疗方法。基于所有这些原因，我们简要回顾了目前关于HF患者身体虚弱、肌肉减少症和恶病质的知识，试图确定临床上多器官功能障碍的显著程度、临床实践中的特定“红色警报”阈值以及治疗方法。
