Abstract
Coronary artery disease is the leading cause of morbidity and mortality even in the
elderly population. Treatment opportunities in the elderly population are often underappreciated.
Revascularization procedures (coronary artery bypass graft surgery and percutaneous
coronary intervention) can be associated with important benefits in symptom control,
quality of life, and long-term mortality, at an upfront cost of an increased risk
of in-hospital mortality and morbidity. Risk models to assess periprocedural risk
are useful. The best models would balance unique aspects of risk with the very real
potential benefit of revascularization. Current models fall short in this regard.
Frailty, a clinical syndrome of vulnerability, is present in 25%-50% of cardiac patients,
and is associated with increased morbidity and mortality. The addition of frailty
can improve the discrimination of risk models. Elderly patients commonly consider
quality of life to have greater importance than mortality outcomes. Furthermore, hospital
admission is associated with a reduction in mobilization, loss of muscle strength,
and worsening frailty, and interferes with a fundamental value in the elderly: the
maintenance of independence. Therefore, an understanding of frailty, quality of life,
and other unique aspects of risk, as well as individual patient goals, can assist
in further defining prognosis and refine decision-making in this important and vulnerable
population.
Résumé
La coronaropathie est la cause principale de morbidité et de mortalité, même dans
la population âgée. On sous-évalue souvent les possibilités de traitement de cette
population âgée. Les interventions de revascularisation (pontage aortocoronarien et
intervention coronarienne percutanée) peuvent être associées à des avantages importants
dans la maîtrise des symptômes, la qualité de vie et la mortalité à long terme au
coût d’une augmentation en amont du risque de mortalité intrahospitalière et de morbidité.
Les modèles de risque qui évaluent le risque péri-interventionnel sont utiles. Les
meilleurs modèles équilibreraient les aspects particuliers du risque avec l’avantage
très réel de la revascularisation. Les modèles actuels ne suffisent pas à cet égard.
La fragilité, un syndrome clinique de vulnérabilité, est présente chez 25 % à 50 %
des patients cardiaques, et est associée à l’augmentation de la morbidité et de la
mortalité. L’ajout de la fragilité peut améliorer la discrimination des modèles de
risque. Les patients âgés considèrent fréquemment la qualité de vie comme étant plus
importante que les résultats de mortalité. De plus, l’hospitalisation est associée
à une réduction de la mobilité, à la perte de la force musculaire et à une plus grande
fragilité, et touche à une valeur fondamentale chez les personnes âgées: le maintien
de l’autonomie. Par conséquent, la compréhension de la fragilité, de la qualité de
vie et des autres aspects particuliers du risque ainsi que des objectifs individuels
des patients peut aider à mieux établir le pronostic et à affiner la prise de décision
chez cette population importante et vulnérable.
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Article info
Publication history
Published online: May 06, 2016
Accepted:
May 4,
2016
Received:
February 8,
2016
Footnotes
See page 1136 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
