|
1
|
Solla-Suárez P, Avanzas P, Pascual I, Bermúdez-Menéndez De La Granda M, Almendarez M, Arche-Coto JM, Hernández-Vaquero D, Lorca R, López-Álvarez E, Álvarez-Velasco R, Moreno-Planillo C, Morís de la Tassa C, Gutiérrez-Rodríguez J. Frailty Assessment in a Cohort of Elderly Patients with Severe Symptomatic Aortic Stenosis: Insights from the FRailty Evaluation in Severe Aortic Stenosis (FRESAS) Registry. J Clin Med 2021; 10:jcm10112345. [PMID: 34071871 PMCID: PMC8197816 DOI: 10.3390/jcm10112345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Precise evaluation of the degree of frailty is a fundamental part of the global geriatric assessment that helps to avoid therapies that could be futile. Our main objective was to determine the prevalence of frailty in a specific consult of patients undergoing aortic valve replacement. Methods: From May 2018 to February 2020, all consecutive patients ≥75 years old, with severe symptomatic aortic stenosis, undergoing valve replacement in the Principality of Asturias (Northern Spain) were evaluated. Results: A total of 286 patients were assessed. The mean age was 84 ± 4.01 years old; 175 (61.2%) were female. The short performance physical battery score was 8.5 ± 2.4 and the prevalence of frailty was 19.6% (56 patients). In the multivariable analysis, age, Barthel index and atrial fibrillation were independent predictors of frailty. Conclusions: The prevalence of frailty in our sample patients undergoing aortic valve replacement, evaluated by a standardized protocol, was 19.6%.
Collapse
Affiliation(s)
- Pablo Solla-Suárez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
| | - Pablo Avanzas
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, 33011 Oviedo, Spain
| | - Isaac Pascual
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Departamento de Biología Funcional, Universidad de Oviedo, 33011 Oviedo, Spain
- Correspondence:
| | - Manuel Bermúdez-Menéndez De La Granda
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
| | - Marcel Almendarez
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Jose M. Arche-Coto
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
| | - Daniel Hernández-Vaquero
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Rebeca Lorca
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Eva López-Álvarez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
| | - Rut Álvarez-Velasco
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Carmen Moreno-Planillo
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
| | - César Morís de la Tassa
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, 33011 Oviedo, Spain
| | - José Gutiérrez-Rodríguez
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| |
Collapse
|
|
2
|
González-Montalvo JI, Ramírez-Martín R, Menéndez Colino R, Alarcón T, Tarazona-Santabalbina FJ, Martínez-Velilla N, Vidán MT, Pi-Figueras Valls M, Formiga F, Rodríguez Couso M, Hormigo Sánchez AI, Vilches-Moraga A, Rodríguez-Pascual C, Gutiérrez Rodríguez J, Gómez-Pavón J, Sáez López P, Bermejo Boixareu C, Serra Rexach JA, Martínez Peromingo J, Sánchez Castellano C, González Guerrero JL, Martín-Sánchez FJ. [Cross-speciality geriatrics: A health-care challenge for the 21st century]. Rev Esp Geriatr Gerontol 2020; 55:84-97. [PMID: 31870507 DOI: 10.1016/j.regg.2019.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent. The use of the term "Cross-speciality Geriatrics" is suggested when geriatric care is provided in clinical areas traditionally outside the reach of Geriatric Teams. The core principles of Geriatric Medicine (comprehensive geriatric assessment, patient-centred multidisciplinary targeted interventions, and input at point-of-care) are adapted to the specifics of each specialty and applied to frail older patients in order to deliver a holistic assessment/treatment, better patient/carer experience, and improved clinical outcomes. Using Comprehensive Geriatric Assessment methodology and Frailty scoring in such patients provides invaluable prognostic information, helps in decision making, and enables personalised treatment strategies. There is evidence that such an approach improves the efficiency of health care systems and patient outcomes. This article includes a review of these concepts, describes existing models of care, presents the most commonly used clinical tools, and offers examples of excellence in this new era of geriatric care. In an ever ageing population it is likely that teams will be asked to provide Cross-specialty Geriatrics across different Health Care systems. The fundamentals for its implementation are in place, but further evidence is required to guide future development and consolidation, making it one of the most important challenges for Geriatrics in the coming years.
Collapse
Affiliation(s)
- Juan Ignacio González-Montalvo
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España.
| | | | | | - Teresa Alarcón
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | | | - Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Madrid, España
| | | | - Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, IDIBELL, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
| | | | - Ana Isabel Hormigo Sánchez
- Servicio de Geriatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Arturo Vilches-Moraga
- Servicio de Geriatría, Salford Royal NHS Foundation Trust, Facultad de Medicina, Universidad de Manchester, Manchester, Inglaterra
| | | | - José Gutiérrez Rodríguez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
| | - Javier Gómez-Pavón
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, España
| | - Pilar Sáez López
- Unidad de Geriatría, Hospital Universitario Fundación de Alcorcón, IdiPAZ, Alcorcón, Madrid, España
| | | | - José Antonio Serra Rexach
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Madrid, España
| | | | | | - José Luis González Guerrero
- Servicio de Geriatría, Hospital San Pedro de Alcántara, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, IdiSSC, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| |
Collapse
|
|
4
|
Castellote Varona FJ, Avilés Hernández JD, García de Lara J, López Cánovas C. [Geriatric assessment before transcatheter aortic valve implantation in elderly patients]. Rev Esp Geriatr Gerontol 2017; 53:169-170. [PMID: 28754509 DOI: 10.1016/j.regg.2017.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/18/2017] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Juan García de Lara
- Unidad de Cardiología Intervencionista, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Carmen López Cánovas
- Unidad de Geriatría, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| |
Collapse
|