衰弱筛查在晚期心力衰竭患者中的可行性。

Feasibility of frailty screening among patients with advanced heart failure.

机构信息

Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA

Harvard Medical School, Boston, Massachusetts, USA.

出版信息

BMJ Open Qual. 2023 Oct;12(4). doi: 10.1136/bmjoq-2023-002430.

DOI:10.1136/bmjoq-2023-002430

PMID:37857523

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10603494/

Abstract

BACKGROUND

Frailty is common among patients with advanced heart failure (HF), and screening for frailty to guide care is recommended. Although multiple tools are available to screen for frailty, the feasibility of routinely incorporating frailty screening into daily clinical practice among hospitalised advanced HF patients has not been rigorously tested.

METHODS

This was a prospective, single-centre, quality improvement study. Two brief frailty screening tools were incorporated into palliative care consultations for all patients ≥50 years from August 2021 to October 2022. In the first phase, the Clinical Frailty Scale (CFS) was implemented, followed by the Study of Osteoporotic Fracture (SOF) tool or a modified SOF (mSOF) version in the second phase. The primary outcome was feasibility (%) of performing frailty screenings for this high-risk population.

RESULTS

A total of 212 patients (mean age 69±10 years, 69% male, 79% white, 30% with ischaemic HF) were referred for palliative care consultation during the study period. Overall, frailty screens were completed in 86% (n=183) of patients. CFS and mSOF reached >80% of adoption, while SOF adoption was 54%. Altogether, 52% of the population screened frail by use of CFS and 52% also by mSOF. All clinicians (n=6) participating in the study reported that frailty screening tools were useful and acceptable, and 83% reported plans for continued utilisation in future clinical practice.

CONCLUSIONS

Frailty screening with CFS or mSOF tools was feasible in hospitalised patients with advanced HF. Tools that require physical assessment were more challenging to implement. These data support the feasibility of incorporating questionnaire-based frailty screening in a busy hospital setting.

摘要

背景

衰弱在晚期心力衰竭（HF）患者中很常见，建议通过筛查衰弱来指导治疗。尽管有多种工具可用于筛查衰弱，但尚未严格测试在住院的晚期 HF 患者中常规纳入衰弱筛查的日常临床实践的可行性。

方法

这是一项前瞻性、单中心的质量改进研究。从 2021 年 8 月到 2022 年 10 月，为所有≥50 岁的患者在姑息治疗咨询中纳入了两种简短的衰弱筛查工具。在第一阶段，实施了临床虚弱量表（CFS），随后在第二阶段实施了骨质疏松性骨折研究（SOF）工具或改良的 SOF（mSOF）版本。主要结局是为这一高危人群进行虚弱筛查的可行性（%）。

结果

在研究期间，共有 212 名（平均年龄 69±10 岁，69%为男性，79%为白人，30%为缺血性 HF）患者被转介接受姑息治疗咨询。总体而言，86%（n=183）的患者完成了虚弱筛查。CFS 和 mSOF 的采用率超过 80%，而 SOF 的采用率为 54%。总共，52%的人群通过 CFS 和 52%的人群通过 mSOF 筛查出虚弱。参与研究的所有临床医生（n=6）均报告称虚弱筛查工具有用且可接受，83%的人计划在未来的临床实践中继续使用。