脆弱性和心力衰竭:最先进的审查状态
Khawaja M Talha1, Ambarish Pandey2, Marat Fudim3,4
1Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
Journal of cachexia, sarcopenia and muscle
|August 16, 2023
概括
虚弱影响超过一半的心力衰竭 (HF) 患者,恶化预后和复杂的治疗. 尽管结果不佳,脆弱的患者仍然可能从指导方针导向疗法中受益,尽管证据有限.
科学领域:
- 心脏病学 心脏病学
- 老年病的医生 老年病的医生
- 内部医学 内部医学
背景情况:
- 虚弱,一种影响从压力中恢复的综合征,影响至少一半的心力衰竭 (HF) 患者.
- 患病率较高的HF与保存的射出分数 (高达90%) 和女性 (~26%比男性).
- 虚弱和HF有双向的关系,相互加剧,增加了sarcopenia风险.
研究的目的:
- 审查心力衰竭患者心力衰弱的特征,评估工具,预后影响和治疗影响.
- 突出管理脆弱HF患者的挑战和需要HF特定评估工具.
主要方法:
- 对心力衰竭中的脆弱性现有文献的综述.
- 讨论历史脆弱性评估方法 (例如,炸脆弱性表型,洛克伍德临床脆弱性尺度).
- 对脆弱人群中HF治疗现有证据的分析.
主要成果:
- 在HF中虚弱与死亡和住院的风险增加了1.5到2倍.
- 超过50%的住院HF患者是脆弱的,结果明显较差.
- 脆弱的患者通常会接受低于最佳的指导方针导向的医疗疗 (<40%的坚持) 由于感知到的危害和缺乏证据.
结论:
- 脆弱性显著恶化HF预后,并使治疗的坚持和有效性复杂化.
- 现有证据表明,基于指导方针的干预措施可能对脆弱的HF患者有好处,甚至可以放大效果.
- 需要进一步的研究,包括随机试验,以优化对这种脆弱人群的护理.
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