Canadian Journal of Cardiology, Год журнала: 2024, Номер 40(4), С. 685 - 687

Опубликована: Янв. 4, 2024

The global burden of heart failure (HF) is rising around the world, driven—in large part—by population aging and improved survival persons with cardiovascular risk factors.1Savarese G. Becher P.M. Lund L.H. et al.Global failure: a comprehensive updated review epidemiology.Cardiovasc Res. 2023; 118 (Erratum: Cardiovasc Res 2023;119:1453): 3272-3287Crossref PubMed Scopus (475) Google Scholar,2Roger V.L. Epidemiology contemporary perspective.Circ 2021; 128: 1421-1434Crossref (364) Scholar HF remains substantial greatest among older patients, who are more likely to experience acute care, functional cognitive decline, death.1Savarese This demographic shift has also seen emergence frailty as an important factor for poor outcomes in this population.3Butt J.H. Dewan P. Jhund P.S. al.Sacubitril/valsartan patients preserved ejection fraction.J Am Coll Cardiol. 2022; 80: 1130-1143Crossref (29) Scholar, 4Dewan Jackson A. al.The prevalence importance reduced fraction - analysis PARADIGM-HF ATMOSPHERE.Eur J Heart Fail. 2020; 22: 2123-2133Crossref (73) 5Talha K.M. Pandey Fudim M. Butler J. Anker S.D. Khan M.S. Frailty State-of-the-Art Review.J Cachexia Sarcopenia Muscle. 14: 1959-1972Crossref (5) graded clinical state characterized by heightened vulnerability adverse health when exposed stressor resulting from accumulation age physiological deficits across multiple organ systems.6Dent E. Hanlon Sim al.EPI-FRAIL consortium. Recent developments identification, management, factors prevention: narrative leading journals geriatrics gerontology.Ageing Rev. 91102082Crossref (4) At least one-half living may be frail, underuse guideline directed therapies, associated higher rates hospitalization death.3Butt common prognostically significant comorbid led recognition Frail Phenotype 2023 Focused Clinical Practice Update Canadian Cardiovascular Society Failure Society.7Ducharme Zieroth S. Ahooja V. al.Canadian Society-Canadian focused practice update differing phenotypes.Can 39: 1030-1040Abstract Full Text PDF However, guidance on how implement care processes better support frail lacking. In issue Journal Cardiology, Fujimoto al.8Fujimoto Y. Matsue Maeda D. al.Association prognostic value multidomain defined cumulative deficit phenotype models failure.Can 2024; 40: 677-684Abstract (1) present post hoc prospective cohort study 1027 ambulatory aged 65 years older, hospitalized diagnosis regardless left ventricular fraction, recruited 15 hospitals Japan. Patients assist devices, had undergone cardiac transplantation, were long-term dialysis, or diagnosed myocarditis excluded. was assessed 4 ways: physical based Fried phenotype; social alone, going out less frequently compared previous year, not visiting friends sometimes, feeling helpful family, talking someone every day;cognitive Mini-Cog assessment; index (FI) 34 items, including some first 3 measures well other performance, clinical, diagnostic measures.9Fried L.P. Tangen C.M. Walston al.Cardiovascular Health Study Collaborative Research GroupFrailty adults: evidence phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156Crossref 10Makizako H. Shimada Doi T. al.Social leads development physically non-frail four-year follow-up longitudinal study.Int Environ Public Health. 2018; 15: 490Crossref (141) 11Borson Scanlan J.M. Chen Ganguli screen dementia: validation population-based sample.J Geriatr Soc. 2003; 51: 1451-1454Crossref (891) 12Mitnitski A.B. Graham J.E. Mogilner A.J. Rockwood K. Frailty, fitness late-life mortality relation chronological biological age.BMC Geriatr. 2002; 2: 1Crossref (524) median 81 years; 58.1% men mean fractions 46%. FI 0.44, which much than that recent randomized trials. After 2 years, 20% died. emerged independent death beyond conventional factors, hazard ratio 1.21 (95% confidence interval, 1.07-1.37) each 0.1 increase FI. Adding scores accuracy, although no difference shown between effect measures. All correlated one another. Clearly, matters. what we do information? reiterates presence can complicate treatment emphasizes shared decision making individualizing planning. concerns about polypharmacy falls involving pharmacists conduct medication reviews. Involvement dietician, occupational therapist, physiotherapist recommended. these interventions represent limited subset gold standard intervention person frailty, Comprehensive Geriatric Assessment (CGA) delivered specialized geriatric service. context, CGA multidimensional interdisciplinary process assessing persons' medical, psychological, capacity develop coordinated integrated plan (Table 1).13Ho L. Malden McGill al.Complex improving quality life amongst community-dwelling systematic meta-analysis.Age Ageing. 52: afad132Crossref 14Yen P.C. Lo Y.T. Lai C.C. al.Effectiveness outpatient evaluation management nursing home admission: meta-analysis controlled trials.BMC 23: 414Crossref (2) 15Yip K.F. Wong T.H. Alhamid S.M. al.Integrating advance planning part assessment hospitalised elderly patients: findings cross-sectional study.Singapore 61: 254-259Crossref (11) When appropriately targeted, reduce prevent fractures, improve cognition mood, caregiver use services, delay institutionalization.13Ho Scholar,14Yen provide useful information advanced-care planning.15Yip ScholarTable 1Elements Assessment13Ho ScholarComprehensive following domains:•Medical: Diagnoses, review, prevention (immunization, fractures)•Neuropsychiatric: Cognition, anxiety, behaviours, psychosis•Physical function: Instrumental basic activities daily living•Health indicators: Nutrition, sarcopenia, pain, skin integrity•Mobility: Gait balance problems, gait aids, falls•Senses: Hearing, vision•Sociodemographic: Caregiving, socioeconomic, situation, supportsProcedures•Identify patient wishes goals•Develop tailored patient's needs overall identifies mitigate potential stressors•Implementation Open table new tab binary "to treat treat" indicator nor it absolute contraindication guideline-directed medical therapy. Although at increased side effects suggests that, many, greater stems undertreatment, even frailty.3Butt Evidence does suggest will benefit disease-management setting doses carefully titrated upward, their partners receive ongoing support.16Pulignano Del Sindaco Di Lenarda al.Usefulness profile targeting disease programs: cost-effectiveness, pilot study.J (Hagerstown). 2010; 11: 739-747Crossref (86) Moreover, close integration primary essential requires coordination different providers responsive evolving throughout journey.17Heckman G.A. Integrated elderly.Healthc Pap. 2011; 11 (discussion 86-91): 62-68Crossref (16) Scholar,18Heckman Hillier Manderson B. McKinnon-Wilson Santi Stolee Developing system seniors.Healthc Manage Forum. 2013; 26: 200-208Abstract (21) achieved through "spoke-hub-node" organization whereby services specialties collaborate closely sector resourced community-based multidisciplinary teams.19Huitema A.A. Harkness Heckman McKelvie R.S. Spoke-hub-and-node model care.Can 34: 863-870Abstract (24) By its very nature, complex time-consuming intervention, system-wide strategy efficient approach case-finding resources those most benefit. methods used assess time intensive too unwieldy impractical implementation into routine under-resourced systems. classify differently, would greatly standards.20Heckman Turcotte Hirdes J.P. crying need validated consensus measurement standards: real please stand up?.Can 37: 1702-1704Abstract Scholar,21Rolfson D.B. Bagshaw Robertson Implementing healthcare system.J Aging. 7: 208-216PubMed identified interRAI instruments foundation upon such system.21Rolfson Designed international nonprofit scientific consortium, systems already widespread Canada many countries. They include brief electronic self-report adults, thus minimizing providers. addition facilitating informational sectors, facilitate comparisons characteristics, indicators, provinces, internationally.22Sinn C.J. Poss J.W. Boscart V.M. Implementation stepped using Ontario, Canada.Health Soc Care Community. 30: 2341-2352Crossref (6) 23Heckman Gimbel Morrison al.Preliminary shared-care, care-based interprofessional program community. Abstracts 42nd Annual Scientific Meeting Geriatrics Society: Compassionate all: renewing our passion, recalibrating compass; April 13-15, Vancouver, British Columbia.Can 290-325PubMed 24Heckman Gray L.C. Addressing seniors Canada: role instruments.CGS CME. 3: 8-16Google add body literature HF. It now act data. To best growing HF, imperative able efficiently identify, assess, concurrent frailty. Optimizing both meeting broader reliance acute-care allow successfully home. authors wish thank Chantelle Mensink comments unpublished letter editor similar topic. Dr supported Schlegel Chair Medicine.

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