虚弱和心力衰竭:最新综述。

IF 8.9 1区 医学 Journal of Cachexia, Sarcopenia and Muscle Pub Date : 2023-08-16 DOI:10.1002/jcsm.13306
Khawaja M. Talha, Ambarish Pandey, Marat Fudim, Javed Butler, Stefan D. Anker, Muhammad Shahzeb Khan
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引用次数: 1

摘要

至少有一半的心力衰竭患者受到虚弱的影响,这种综合征限制了个人从急性压力源中恢复的能力。尽管射血分数保持的HF患者中有高达90%患有虚弱,但射血分数降低的HF患者也有约30-60%患有虚弱,女性的患病率比男性高约26%。虚弱和HF之间的关系是双向的,两种情况都会加剧另一种情况。与无HF患者相比,HF患者的少肌症患病率更高(约20%),这对结果产生了负面影响,从而使虚弱更加复杂。历史上已经采用了几种虚弱评估方法,包括Fried虚弱表型和Rockwood临床虚弱量表,根据虚弱的严重程度对HF患者进行分类;然而,目前还不存在经过验证的HF特异性虚弱评估工具。HF的虚弱与预后不良有关,与非虚弱患者相比,全因死亡和住院的风险高1.5至2倍。虚弱在心衰恶化的患者中也非常普遍,影响了50%以上因心衰住院的患者。与年轻、非虚弱的队列相比,这类因失代偿性心衰多次再次入院的患者的预后明显较差,据推测,这可能是由于严重的身体和功能限制,限制了心衰恶化急性发作的恢复,HF指南中未提及的护理方面。虚弱的患者被认为从治疗干预中获益较少,因为感知到伤害的风险增加,导致对HF干预的依从性降低,这可能会恶化结果。多项研究报告称
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Frailty and heart failure: State-of-the-art review

At least half of all patients with heart failure (HF) are affected by frailty, a syndrome that limits an individual ability to recover from acute stressors. While frailty affects up to 90% of patients with HF with preserved ejection fraction, it is also seen in ~30–60% of patients with HF with reduced ejection fraction, with ~26% higher prevalence in women compared with men. The relationship between frailty and HF is bidirectional, with both conditions exacerbating the other. Frailty is further complicated by a higher prevalence of sarcopenia (by ~20%) in HF patients compared with patients without HF, which negatively affects outcomes. Several frailty assessment methods have been employed historically including the Fried frailty phenotype and Rockwood Clinical Frailty Scale to classify HF patients based on the severity of frailty; however, a validated HF-specific frailty assessment tool does not currently exist. Frailty in HF is associated with a poor prognosis with a 1.5-fold to 2-fold higher risk of all-cause death and hospitalizations compared to non-frail patients. Frailty is also highly prevalent in patients with worsening HF, affecting >50% of patients hospitalized for HF. Such patients with multiple readmissions for decompensated HF have markedly poor outcomes compared to younger, non-frail cohorts, and it is hypothesized that it may be due to major physical and functional limitations that limit recovery from an acute episode of worsening HF, a care aspect that has not been addressed in HF guidelines. Frail patients are thought to confer less benefit from therapeutic interventions due to an increased risk of perceived harm, resulting in lower adherence to HF interventions, which may worsen outcomes. Multiple studies report that <40% of frail patients are on guideline-directed medical therapy for HF, of which most are on suboptimal doses of these medications. There is a lack of evidence generated from randomized trials in this incredibly vulnerable population, and most current practice is governed by post hoc analyses of trials, observational registry-based data and providers' clinical judgement. The current body of evidence suggests that the treatment effect of most guideline-based interventions, including medications, cardiac rehabilitation and device therapy, is consistent across all age groups and frailty subgroups and, in some cases, may be amplified in the older, more frail population. In this review, we discuss the characteristics, assessment tools, impact on prognosis and impact on therapeutic interventions of frailty in patients with HF.

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来源期刊
Journal of Cachexia, Sarcopenia and Muscle
Journal of Cachexia, Sarcopenia and Muscle Medicine-Orthopedics and Sports Medicine
自引率
12.40%
发文量
0
期刊介绍: The Journal of Cachexia, Sarcopenia, and Muscle is a prestigious, peer-reviewed international publication committed to disseminating research and clinical insights pertaining to cachexia, sarcopenia, body composition, and the physiological and pathophysiological alterations occurring throughout the lifespan and in various illnesses across the spectrum of life sciences. This journal serves as a valuable resource for physicians, biochemists, biologists, dieticians, pharmacologists, and students alike.
期刊最新文献
Comment on 'Diagnosis of Sarcopenia by Evaluating Skeletal Muscle Mass by Adjusted Bioimpedance Analysis Validated With Dual-Energy X-Ray Absorptiometry' by Cheng et al. Comment on 'Association Between Dynapenic Obesity and Risk of Cardiovascular Disease: The Hisayama Study' by Setoyama et al. Comment on 'Detection of Cancer-Associated Cachexia in Lung Cancer Patients Using Whole-Body [18F]FDG-PET/CT Imaging: A Multicentre Study' by Ferrara et al. Comment on 'Factors Associated With Skeletal Muscle Mass in Middle-Aged Men Living With HIV' by Xu et al. Comment on 'Impact of Cachexia and First-Line Systemic Therapy for Previously Untreated Advanced Non-Small Cell Lung Cancer: NEJ050A' by Miura et al.
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