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Revisión por expertos

Fragilidad y cardiopatía isquémica

Nahuel Litwak, Julio Panza

Revista del Consejo Argentino de Residentes de Cardiología ;():0080-0086 


La fragilidad es un síndrome biológico caracterizado por una alteración en la reserva fisiológica y una consiguiente vulnerabilidad frente a diferentes estresores. Dada la elevada prevalencia de esta situación en la práctica clínica habitual y particularmente en la enfermedad cardiovascular, resulta esencial el conocimiento de esta entidad, los métodos existentes para su detección y el abordaje pertinente considerando su rol en la predicción de eventos adversos. Actualmente la investigación de la fragilidad ocupa un rol central como un factor determinante del pronóstico de nuestros pacientes.


Palabras clave: cardiopatía isquémica; enfermedades cardiovasculares; anciano frágil; pronóstico,

Frailty is a biological syndrome characterized by an alteration in the physiological reserve and a consequent vulnerability to different stressors. Given the high prevalence of this situation in routine clinical practice and particularly in cardiovascular disease, knowledge of this entity, the existing methods for its detection and the relevant approach considering its role in the prediction of adverse events is essential. Currently, frailty research occupies a central role as a determining factor in the prognosis of our patients.


Keywords: myocardial ischemia; cardiovascular diseases; frail elderly; prognosis,


Los autores declaran no poseer conflictos de intereses.

Fuente de información Consejo Argentino de Residentes de Cardiología. Para solicitudes de reimpresión a Revista del CONAREC hacer click aquí.

Recibido 2018-05-10 | Aceptado 2018-05-15 | Publicado 2018-10-31

Figura 1. La encrucijada entre la edad, la enfermedad cardiovascular y la fragilidad. A pesar de que...

Figura 2. Mortalidad o morbilidad mayor en relación a la prueba de la velocidad de la marcha (Gait ...

  1. Fried LP, Borhani NO, Enright P, Furberg CD, Gardin JM, Kronmal RA et al. The Cardiovascular Health Study: design and rationale. Ann Epidemiol 1991;1(3):263-76.

  2. Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 2014;63(8):747-62.

  3. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56(3):146-56.

  4. Finn M, Green P. Influencia de la fragilidad del paciente en las enfermedades cardiovasculares. Rev Esp Cardiol 2015;68(8):653-6.

  5. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59(3):255-63.

  6. Walston J, Hadley EC, Ferrucci L, Gualnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 2006;54(6):991-1001.

  7. Chen MA. Frailty and cardiovascular disease: potential role of gait speed in surgical risk stratification in older adults. J Geriatr Cardiol. 2015;12(1):44-56.

  8. Schwartz JP, Zipes DP. Enfermedades cardiovasculares en adultos mayores. En Mann D, Zipes DP, Libby P, Bonow RO, Braunwald, Tratado de Cardiología: texto de medicina cardiovascular (2015, Décima edición, 1711-1743). España: Editorial Elsevier.

  9. Candore G, Caruso C, Jirillo E, Magrone T, Vasto S. Low grade inflammation as a common pathogenetic denominator in age-related diseases: novel drug targets for anti-ageing strategies and successful ageing achievement. Curr Pharm Des 2010;16(6):584-96.

  10. Cesari M, Penninx BW, Pahor M, Lauretani F, Corsi AM, Rhys Williams G, et al. Inflammatory markers and physical performance in older persons: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2004;59(3):242-8.

  11. Schaap LA, Pluijm SM, Deeg DJ, Harris TB, Kritchevsky SB, Newman AB, et al. Higher inflammatory marker levels in older persons: associations with 5-year change in muscle mass and muscle strength. J Gerontol A Biol Sci Med Sci 2009;64(11):1183-9.

  12. Joyce E. Frailty in Advanced Heart Failure. Heart Fail Clin 2016;12(3):363-74.

  13. Warwick J, Falaschetti E, Rockwood K, Mitnitski A, Thijs L, Beckett N, et al. No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: an investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over. BMC Med 2015(9);13:78.

  14. Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, et al. Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial. JAMA 2016;315(24):2673-82.

  15. Mallery LH, Allen M, Fleming I, Kelly K, Bowles S, Duncan J, et al. Promoting higher blood pressure targets for frail older adults: a consensus guideline from Canada. Cleve Clin J Med 2014;81(7):427-37.

  16. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 2012;60(8):1487-92.

  17. Kojima G, Iliffe S, Taniguchi Y, Shimada H, Rakugi H, Walters K. Prevalence of frailty in Japan: A systematic review and meta-analysis. J Epidemiol 2017;27(8):347-353.

  18. Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J. Prevalence of Frailty in Middle-Aged and Older Community-Dwelling Europeans Living in 10 Countries. J Gerontol A Biol Sci Med Sci 2009;64(6):675–681.

  19. Alvarado BE, Zunzunegui MV, Béland F, Bamvita JM. Life course social and health conditions linked to frailty in Latin American older men and women. J Gerontol A Biol Sci Med Sci 2008;63(12):1399-406.

  20. Varela-Pinedo L, Ortiz-Saavedra PJ, Chavez-Jimeno H. Velocidad de la marcha como indicador de fragilidad en adultos mayores de la comunidad en Lima, Peru. Rev Esp Geriatr Gerontol 2010;45(1):22-25

  21. Aguilar-Navarro S, Gutierrez-Robledo LM, Garcia-Lara JMA, Payette H, Amieva H, Avila-Funes JA. The phenotype of frailty predicts disability and mortality among Mexican community-dwelling elderly. J Frailty Aging 2012;1(3):111–117.

  22. Gomez F, Curcio CL, Henao GM: Fragilidad en ancianos colombianos. Rev. Medica Sanitas 2012;15(4):8-16.

  23. Curcio CL, Henao GM, Gomez F. Frailty among rural elderly adults. BMC Geriatrics 2014;14(1):2.

  24. Sousa AC, Dias RC, Maciel AC, Guerra RO: Frailty syndrome and associated factors in community-dwelling elderly in Northeast Brazil. Arch Gerontol Geriatr 2012;54(2):e95–e101.

  25. Shlipak MG, Stehman-Breen C, Fried LF, Song X, Siscovick D, Fried LP, et al. The presence of frailty in elderly persons with chronic renal insufficiency. Am J Kidney Dis 2004;43(5):861-7.

  26. Johansen KL, Chertow GM, Jin C, Kutner NG. Significance of frailty among dialysis patients. J Am Soc Nephrol 2007;18(11):2960-7.

  27. Galizia G, Cacciatore F, Testa G, Della-Morte D, Mazzella F, Langellotto A, et al. Role of clinical frailty on long-term mortality of elderly subjects with and without chronic obstructive pulmonary disease. Aging Clin Exp Res 2011;23(2):118-25.

  28. Lahousse L, Ziere G, Verlinden VJ, Zillikens MC, Uitterlinden AG, Rivadeneira F, et al. Risk of Frailty in Elderly With COPD: A Population-Based Study. J Gerontol A Biol Sci Med Sci 2016;71(5):689-95.

  29. Handforth C, Clegg A, Young C, Simpkins S, Seymour MT, Selby PJ, et al. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol 2015;26(6):1091-101.

  30. Afilalo J, Karunananthan S, Eisenberg MJ, Alexander KP, Bergman H. Role of frailty in patients with cardiovascular disease. Am J Cardiol 2009;103(11):1616-21.

  31. Newman AB, Gottdiener JS, Mcburnie MA, Hirsch CH, Kop WJ, Tracy R, et al. Associations of subclinical cardiovascular disease with frailty. J Gerontol A Biol Sci Med Sci 2001;56(3):158-66.

  32. Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, et al. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc 2005;53(8):1321-30.

  33. Webb J, Gerosa G, Lefèvre T, Leipsic J, Spence M, Thomas M, et al. Multicenter evaluation of a next-generation balloon-expandable transcatheter aortic valve. J Am Coll Cardiol 2014;64(21):2235-43.

  34. Afilalo J, Lauck S, Kim DH, Lefèvre T, Piazza N, Lachapelle K, et al. Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study. J Am Coll Cardiol 2017;70(6):689-700.

  35. Malmstrom TK, Miller DK, Morley JE. A comparison of four frailty models. J Am Geriatr Soc 2014;62(4):721-6.

  36. Afilalo J. Frailty in Patients with Cardiovascular Disease: Why, When, and How to Measure. Curr Cardiovasc Risk Rep 2011(5):467-472.

  37. Sarkisian CA, Gruenewald TL, John Boscardin W, Seeman TE. Preliminary evidence for subdimensions of geriatric frailty: the MacArthur study of successful aging. J Am Geriatr Soc 2008;56(12):2292-7.

  38. Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging 2008;12(1):29-37.

  39. Studenski S, Perera S, Wallace D, Chandler JM, Duncan PW, Rooney E, et al. Physical performance measures in the clinical setting. J Am Geriatr Soc 2003;51(3):314-22.

  40. Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, et al. Gait speed and survival in older adults. JAMA 2011;305(1):50-8.

  41. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173(5):489-95.

  42. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49(2):85-94.

  43. Fisher S, Ottenbacher KJ, Goodwin JS, Graham J, Ostir GV. Short Physical Performance Battery in Hospitalized Older Adults. Aging Clin Exp Res 2009;21(6): 445.

  44. Abellan van Kan G, Rolland YM, Morley JE, Vellas B. Frailty: toward a clinical definition. J Am Med Dir Assoc 2008;9(2):71-2.

  45. Woo J, Leung J, Morley JE. Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation. J Am Geriatr Soc 2012;60(8):1478–1486.

  46. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012;16(7):601–608.

  47. Khan H, Kalogeropoulos AP, Georgiopoulou VV, Newman AB, Harris TB, Rodondi N, et al. Frailty and risk for heart failure in older adults: the health, aging, and body composition study. Am Heart J 2013;166(5):887-94.

  48. Shimura T, Yamamoto M, Kano S, Kagase A, Kodama A, Koyama Y, et al. Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement. Circulation 2017;135(21):2013-2024.

  49. Afilalo J, Eisenberg MJ, Morin JF, Bergman H, Monette J, Noiseux N, et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol 2010;56(20):1668-76.

  50. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34(38):2949-3003.

  51. Corti MC, Salive ME, Guralnik JM. Serum albumin and physical function as predictors of coronary heart disease mortality and incidence in older persons. J Clin Epidemiol 1996;49(5):519-26.

  52. Purser JL, Kuchibhatla MN, Fillenbaum GG, Harding T, Peterson ED, Alexander KP. Identifying frailty in hospitalized older adults with significant coronary artery disease. J Am Geriatr Soc 2006;54(11):1674–81.

  53. Gharacholou SM, Roger VL, Lennon RJ, Rihal CS, Sloan JA, Spertus JA, et al. Comparison of frail patients versus nonfrail patients ≥65 years of age undergoing percutaneous coronary intervention. Am J Cardiol 2012;109(11):1569–75.

  54. Singh M, Rihal CS, Lennon RJ, Spertus JA, Nair KS, Roger VL. Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes 2011;4(5):496–502.

  55. Ekerstad N, Swahn E, Janzon M, Alfredsson J, Lofmark R, Lindenberger M, et al. Frailty is independently associated with short-term outcomes for elderly patients with non—ST-segment elevation myocardial infarction. Circulation 2011;124(22):2397–404.

  56. Ekerstad N, Swahn E, Janzon M, Alfredsson J, Löfmark R, Lindenberger M, et al. Frailty is independently associated with 1-year mortality for elderly patients with non-ST-segment elevation myocardial infarction. Eur J Prev Cardiol 2014;21(10):1216-24.

  57. TIME investigators. Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial. Lancet 2001;358(9286):951-7.

  58. Pfisterer M. Long-term outcome in elderly patients with chronic angina managed invasively versus by optimized medical therapy: four-year follow-up of the randomized Trial of Invasive versus Medical therapy in Elderly patients (TIME). Circulation 2004;110(10):1213-8.

  59. Rosengren A, Wallentin L, Simoons M, Gitt AK, Behar S, Battler A, et al. Age, clinical presentation, and outcome of acute coronary syndromes in the Euroheart acute coronary syndrome survey. Eur Heart J 2006;27(7):789–795.

  60. Skolnick AH, Alexander KP, Chen AY, Roe MT, Pollack CV Jr, Ohman EM, et al. Characteristics, management, and outcomes of 5,557 patients age ≥90 years with acute coronary syndromes: results from the CRUSADE initiative. J Am Coll Cardiol 2007;49(17):1790 –1797.

  61. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2015;37(3)267-315.

  62. Tegn N, Abdelnoor M, Aaberge L, Endresen K, Smith P, Aakhus S, et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. Lancet 2016;387(10023):1057-1065.

  63. Sanchis J, Bonanad C, Ruiz V, Fernández J, García-Blas S, Mainar L, et al. Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome. Am Heart J 2014;168(5):784-91.

  64. Sündermann SH, Dademasch A, Seifert B, Rodriguez Cetina Biefer H, Emmert MY, Walther T, et al. Frailty is a predictor of short- and mid-term mortality after elective cardiac surgery independently of age. Interact Cardiovasc Thorac Surg 2014;18(5):580-5.

  65. Singh M, Stewart R, White H. Importance of frailty in patients with cardiovascular disease. Eur Heart J 2014;35(26):1726-31.

  66. Lindman BR, Alexander KP, O’Gara PT, Afilalo J. Futility, Benefit, and Transcatheter Aortic Valve Replacement JACC Cardiovasc Interv.2014;7(7):707–716.

  67. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013;14(6):392-7.

  68. Bibas L, Levi M, Bendayan M, Mullie L, Forman DE, Afilalo J. Therapeutic interventions for frail elderly patients: part I. Published randomized trials. Prog Cardiovasc Dis 2014;57(2):134-43.

Autores

Nahuel Litwak
Residente de Cardiología, Hospital Universitario Fundación Favaloro..
Julio Panza
Jefe de Cardiología, Westchester Medical Center y WMC Health Network. Profesor de Medicina y Cátedra de Cardiología, Facultad de Medicina de Nueva York.

Autor correspondencia

Nahuel Litwak
Residente de Cardiología, Hospital Universitario Fundación Favaloro..

Correo electrónico: nahuel.litwak@gmail.com

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Titulo
Fragilidad y cardiopatía isquémica

Autores
Nahuel Litwak, Julio Panza

Publicación
Revista del CONAREC

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Consejo Argentino de Residentes de Cardiología

Fecha de publicación
2018-10-31

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© Consejo Argentino de Residentes de Cardiología

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