Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018–2021.Metho...Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018–2021.Methods This was an ambispective cohort study. A total of 85 older adults participating in the Chronic Heart Failure Program at Guillermo Almenara National Hospital were included. Each had an initial frailty assessment, forming two cohorts: frail and non-frail older adults. Medical records were reviewed, and patients were followed for one year to track events of interest(hospitalization and mortality). Overall survival and risk factors for hospitalization and death were determined.Results During follow-up, 15.3% of the older adults died, and frailty was identified in 58.8% of the patients. Overall survival using the Kaplan-Meier method was 96.5% at 3 months after entering the Chronic Heart Failure Program;92.9% at 6 months;and85.9% at one year. Multivariate analysis using Poisson regression found that frailty was not a risk factor for hospitalization(a RR =0.92;95% CI: 0.42–2.03). Survival analysis using the Cox proportional hazards model showed that frailty was also not a risk factor for mortality after one year of follow-up(a HR = 1.32;95% CI: 0.27–6.53).Conclusions Our research does not confirm frailty as a risk factor for hospitalization or mortality in older adults enrolled in the“Chronic Heart Failure Program” after one year of follow-up.展开更多
Background Frailty is common and significantly impacts prognosis in heart failure(HF). The Vulnerable Elders Survey-13(VES-13), widely used in oncogeriatrics and public health, remains unexplored as a frailty screenin...Background Frailty is common and significantly impacts prognosis in heart failure(HF). The Vulnerable Elders Survey-13(VES-13), widely used in oncogeriatrics and public health, remains unexplored as a frailty screening tool in HF outpatients. In this study, we prospectively evaluated VES-13 against a multimodal screening assessment in detecting frailty and predicting individual risk of adverse prognosis.Methods Frailty was assessed at the initial visit using both a multimodal approach, incorporating Barthel Index, Older American Resources and Services scale, Pfeiffer Test, abbreviated Geriatric Depression Scale, age > 85 years, lacking support systems,and VES-13. Patients scoring ≥ 3 on VES-13 or meeting at least one multimodal criterion were classified as frail. Endpoints included all-cause mortality, a composite of death or HF hospitalization, and recurrent HF hospitalizations.Results A total of 301 patients were evaluated. VES-13 identified 40.2% as frail and the multimodal assessment 33.2%. In Cox regression analyses, frailty identified by VES-13 showed greater prognostic significance than the multimodal assessment for allcause mortality(HR = 3.70 [2.15–6.33], P < 0.001 vs. 2.40 [1.46–4.0], P = 0.001) and the composite endpoint(HR = 3.13 [2.02–4.84], P< 0.001 vs. 1.96 [1.28–2.99], P = 0.002). Recurrent HF hospitalizations were four times more frequent in VES-13 frail patients while two times in those identified as frail by the multimodal assessment. Additionally, stratifying patients by VES-13 tertiles provided robust risk differentiation.Conclusions VES-13, a simple frailty tool, outperformed a comprehensive multimodal assessment and could be easily integrated into routine HF care, highlighting its clinical utility in identifying patients at risk for poor outcomes.展开更多
Frailty is a geriatric syndrome characterized by a reduced ability to maintain homeostasis due to age-related declines in physiological reserves.It increases the risk of adverse health outcomes such as falls,hospitali...Frailty is a geriatric syndrome characterized by a reduced ability to maintain homeostasis due to age-related declines in physiological reserves.It increases the risk of adverse health outcomes such as falls,hospitalization,disability,and mortality,especially in older adults.Key risk factors for frailty include cancer,chronic obstructive pulmonary disease,and cerebrovascular disease.Several models of frailty exist,including the physical frailty phenotype,the deficit accu-mulation model,and mixed physical-psychosocial models.Numerous tools are available for assessment.Cognitive dysfunction is closely related to frailty,sharing underlying mechanisms such as oxidative stress,inflammation,and vascular pathologies.Additionally,social frailty,which can be exacerbated by isolation and limited social support,further complicates the challenges faced by frail individuals.It is recommended that frailty screening,particularly through gait speed assessment,can be conducted in primary healthcare settings.Despite existing guidelines,there is still no consensus on the definition,screening,and diagnosis of frailty.This emphasizes the necessity for additional research to conduct a conceptual diagnosis and screen the older population.Artificial intel-ligence approaches show promise in identifying frail patients and managing their care.展开更多
BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential t...BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.展开更多
BACKGROUND Non-ST-elevation myocardial infarction(NSTEMI)is a prevalent acute coronary syndrome among the elderly,a population often underrepresented in clinical trials.Frailty,a marker of physiologic vulnerability,ma...BACKGROUND Non-ST-elevation myocardial infarction(NSTEMI)is a prevalent acute coronary syndrome among the elderly,a population often underrepresented in clinical trials.Frailty,a marker of physiologic vulnerability,may influence the risks and benefits of percutaneous coronary intervention(PCI)in these patients.AIM To evaluate the impact of frailty status on in-hospital outcomes among patients aged≥75 years with NSTEMI undergoing PCI.METHODS We conducted a retrospective cohort study using the 2021-2022 National Inpatient Sample to evaluate the impact of frailty on in-hospital outcomes among NSTEMI patients aged≥75 years undergoing PCI.Patients were stratified into three frailty categories using the Hospital Frailty Risk Score.Multivariable logistic and generalized linear models with interaction terms assessed the association between frailty and clinical outcomes.RESULTS Among 456690 NSTEMI admissions,37.95%,50.71%,and 11.34%were categorized as low,intermediate,and high frailty,respectively.PCI use declined with increasing frailty(35.0%in low vs 7.5%in high;P<0.001).Adjusted mortality was lower with PCI across all frailty levels[odds ratios(OR):0.27(low),0.37(intermediate),0.43(high);all P<0.001].However,the mortality benefit was attenuated with increasing frailty(interaction OR:1.56 and 1.83 for intermediate and high vs low frailty;P<0.001).Frailty was independently associated with higher odds of complications,including acute kidney injury,respiratory failure,delirium,and bleeding.PCI was associated with shorter hospital stays in low(-0.90 days)but longer in the high-frail category(+2.47 days;P<0.001),and increasing frailty correlated with significantly higher hospital charges.CONCLUSION In elderly NSTEMI patients,PCI conferred a survival benefit across all frailty strata,although with a diminishing magnitude as frailty increased.Frailty correlated with increased complications and healthcare resource utilization.展开更多
Background Cardiovascular disease(CVD)and frailty are interrelated conditions prevalent in aging populations,yet their dynamic temporal relationship remains underexplored.This study investigates longitudinal changes i...Background Cardiovascular disease(CVD)and frailty are interrelated conditions prevalent in aging populations,yet their dynamic temporal relationship remains underexplored.This study investigates longitudinal changes in frailty trajectories before and after incident CVD across diverse cohorts.Methods Utilizing data from four longitudinal,multinational cohorts(ELSA,HRS,CHARLS,SHARE;n=66,537),we constructed the frailty index(FI)based on age-related health deficits,using 40,40,42,and 44 items from ELSA,HRS,CHARLS and SHARE,respectively.Linear mixed models assessed FI changes pre-and post-CVD,adjusting for demographics,lifestyle,and baseline FI.Sensitivity analyses excluded hypertension,diabetes,and arthritis to mitigate confounding.Results Frailty increased steadily before CVD onset(pre-CVD slope:ELSAβ=0.005,HRSβ=0.005,CHARLSβ=0.012,SHAREβ=0.007;all P<0.001),with an acute FI spike at diagnosis(post-CVD acute change:ELSAβ=0.024,HRSβ=0.031,CHARLSβ=0.046,SHAREβ=0.038;all P<0.001).Post-CVD,frailty progression further accelerated(ELSAβ=0.008,HRSβ=0.005,CHARLSβ=0.017,SHAREβ=0.010;all P<0.001).Sensitivity analyses confirmed robustness across age strata and FI definitions.Conclusions This first multinational study demonstrates bidirectional acceleration of frailty around CVD onset,highlighting their close temporal interplay.These findings suggest that incorporating frailty assessment into CVD management may help identify high-risk individuals and support timely,multidimensional care in aging populations.展开更多
Background Frailty is a major determinant of outcomes in patients with coronary artery disease(CAD)undergoing lower limb amputation.This study evaluates the impact of frailty on in-hospital outcomes in these patients....Background Frailty is a major determinant of outcomes in patients with coronary artery disease(CAD)undergoing lower limb amputation.This study evaluates the impact of frailty on in-hospital outcomes in these patients.Methods We performed a retrospective analysis of the National Inpatient Sample(2016–2021)to identify adult patients with CAD who underwent lower limb amputation.Frailty was defined using the Johns Hopkins Adjusted Clinical Groups(ACG)frailty indicator.Multivariable logistic regression was used to assess the independent association of frailty with in-hospital outcomes,and propensity score matching(PSM)was performed to further account for confounding factors.Results After PSM,9,990 patients were included in each cohort.Frail patients experienced higher rates of in-hospital mortality(3.9%vs.1.5%,P<0.001),acute limb ischemia(3.8%vs.3.1%,P=0.015),fasciotomy(2.1%vs.1.4%,P<0.001),stump infection(7.9%vs.6.6%,P<0.001),cardiogenic shock(0.9%vs.0.7%,P=0.032),sudden cardiac arrest(2.7%vs.2.1%,P=0.004),mechanical circulatory support(0.3%vs.0.2%,P=0.028),major adverse cardiac and cerebrovascular events(7.7%vs.5.4%,P<0.001),and sepsis(18.3%vs.13.8%,P<0.001).In multivariable logistic regression analysis,frailty remained an independent predictor of inhospital mortality and major complications.Conclusion Frailty is independently associated with increased in-hospital mortality and adverse events among CAD patients undergoing lower limb amputation.Incorporating frailty assessment into preoperative evaluation may improve risk stratification and guide clinical decision-making in this high-risk population.展开更多
Objective Burning solid cooking fuel contributes to household air pollution and is associated with frailty.However,how solid cooking fuel use contributes to the development of frailty has not been well illustrated.Met...Objective Burning solid cooking fuel contributes to household air pollution and is associated with frailty.However,how solid cooking fuel use contributes to the development of frailty has not been well illustrated.Methods This study recruited 8,947 participants aged≥45 years from the China Health and Retirement Longitudinal Study,2011–2018.Group-based trajectory modeling was employed to identify frailty trajectories.Multinomial logistic regression was used to assess the association between solid cooking fuel use and frailty trajectories.Population-attributable fractions were used to estimate the frailty burden from solid fuel use.Results We identified three frailty trajectories:low-stable(n=5,789),moderate-increasing(n=2,603),and fast-increasing(n=555).Solid fuel use was associated with higher odds of being in the moderate-increasing(OR:1.24,95%CI:1.08–1.42)and fast-increasing(OR:1.48,95%CI:1.14–1.92)trajectories.These associations were strengthened by longer solid fuel use(P for trend<0.001).Switching to clean fuel significantly reduced the risk of being in these trajectories compared with persistent solid fuel users.Without solid fuel,8%of moderate-and 19%of fast-increasing trajectories demonstrated frailty development like the low-stable group.Conclusion Solid cooking fuel use is associated with frailty trajectories in middle-aged and older Chinese populations.展开更多
Frailty has emerged as a pivotal determinant of post-liver transplant(LT)outcomes,yet its integration into clinical practice remains inconsistent.Defined by functional impairments and reduced physiologic reserve,frail...Frailty has emerged as a pivotal determinant of post-liver transplant(LT)outcomes,yet its integration into clinical practice remains inconsistent.Defined by functional impairments and reduced physiologic reserve,frailty transcends traditional metrics like the model for end-stage liver disease(MELD)score,demonstrating increasing predictive value for mortality beyond the immediate postoperative period.Recent findings suggest that frail recipients experience significantly higher mortality within the first 12 months following transplantation—a period when traditional monitoring often wanes.This raises critical questions about the adequacy of current assessment and follow-up protocols.The observed dissociation between MELD scores and long-term survival underscores the limitations of existing selection criteria.Frailty,as a dynamic and modifiable condition,represents an opportunity for targeted intervention.Prehabilitation programs focusing on nutritional optimization,physical rehabilitation,and psychosocial support could enhance resilience in transplant candidates,reducing their risk profile and improving post-transplant outcomes.Furthermore,these findings call for an expanded approach to post-transplant monitoring.Extending surveillance for frail recipients beyond standard timelines may facilitate early detection of complications,mitigating their impact on survival.Incorporating frailty into both pre-and post-transplant protocols could redefine how transplant centers evaluate and manage risk.This editorial advocates for a paradigm shift:Frailty must no longer be viewed as a secondary consideration but as a core element in LT care.By addressing frailty comprehensively,we can move toward more personalized,effective strategies that improve survival and quality of life for LT recipients.展开更多
Objectives:This study aimed to develop a mobile frailty management platform for Chinese communitydwelling older adults and evaluate its effectiveness,usability and safety.Methods:Based on literature research,the resea...Objectives:This study aimed to develop a mobile frailty management platform for Chinese communitydwelling older adults and evaluate its effectiveness,usability and safety.Methods:Based on literature research,the research team combined the frailty cycle and integration models,self-determination theory,and technology acceptance models and determined the frailty interventions through expert discussion,then transformed it into multimedia resources,finally,engineers developed the mobile management platform.A cluster sampling,parallel,single-blind,controlled quasiexperimental trial was conducted.Sixty older adults from two community health service centers were recruited from March to August 2023.The control group received routine community care,while the intervention group used the mobile frailty management platform.The incidence of frailty,scores of quality of life,depression,sleep quality,and grip strength within 12 weeks were compared between the two groups,and the availability and safety of the platform were assessed.Results:A total of 52 participants completed the study,27 in the intervention group and 25 in the control group.At 12 weeks after the intervention,the frailty state of the intervention group was reversed to prefrailty.There were no significant differences in the scores of quality of life,depression,sleep quality,and grip strength between the two groups before and 4 weeks after intervention.At 8 weeks and 12 weeks after the intervention,the quality of life,depression,and grip strength of the intervention group were improved with statistical significance(P<0.05).Sleep quality was statistically significant only 12 weeks after the intervention(P<0.05).System Usability Scale score for the platform was(87.96±5.88),indicating a highly satisfactory user experience.Throughout the intervention,no adverse events were reported among the older adults.Conclusions:The mobile frailty management platform effectively improved frailty status,depressive mood,sleep quality,grip strength,and quality of life for Chinese community-dwelling older adults.It holds clinical application value and is an effective tool for strengthening frailty management among Chinese community-dwelling older adults.展开更多
This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter...This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.展开更多
Background Physical frailty and depression may share common pathophysiological pathways associated with dementia and thus interact with each other.However,previous studies have primarily focused on the individual impa...Background Physical frailty and depression may share common pathophysiological pathways associated with dementia and thus interact with each other.However,previous studies have primarily focused on the individual impact of these factors on dementia.Aims To examine the joint effect and interaction of physical frailty and depression on the risk of all-cause dementia.Methods We conducted prospective analyses among participants aged≥60 years from three cohorts:the UK Biobank(UKB),the English Longitudinal Study of Ageing(ELSA)and the Health and Retirement Study(HRS).Physical frailty was assessed using modified versions of the Fried frailty phenotype.Depression was evaluated through mental health questionnaires or combined with hospital admission records.The primary outcome was incident all-cause dementia,identified via active follow-up and passive surveillance.Cox proportional hazards models were used to estimate the hazard ratios(HRs)and 95%confidence intervals(CIs).Results A total of 220947 participants(mean age:64.5 years;53.3%female)were included.Over 2832696 person-years of follow-up,9088 participants(7605 in UKB,1207 in HRS and 276 in ELSA)developed incident all-cause dementia.Compared with robust individuals,frail participants faced a 155%increased risk of dementia(pooled HR:2.55,95%CI 2.36 to 2.76;I2=72.3%).Depression conferred a 1.59-fold excess risk for dementia(pooled HR:1.59,95%CI 1.50 to 1.69;I2=56.8%).Adding physical frailty and depression to a traditional dementia risk model significantly improved prediction accuracy(all p-Δarea under the curve<0.05).Jointly,participants with both physical frailty and depression exhibited the highest dementia risk(pooled HR:3.23,95%CI 2.86 to 3.65;I2=41.6%)compared with those without physical frailty and depression.Moreover,a significant additive interaction between physical frailty and depression was observed(pooled relative excess risk due to interaction:0.38,95%CI 0.13 to 0.63),with 17.1%(95%CI 6.0%to 28.3%)of dementia risk attributed to their interactive effects.Conclusions Individuals with both physical frailty and depression had the highest risk of dementia.More importantly,these two factors interact in an additive manner,further amplifying dementia risk.展开更多
Cirrhosis represents the end stage of chronic liver disease,significantly reducing life expectancy as it progresses from a compensated to a decompensated state,leading to serious complications.Recent improvements in m...Cirrhosis represents the end stage of chronic liver disease,significantly reducing life expectancy as it progresses from a compensated to a decompensated state,leading to serious complications.Recent improvements in medical treatment have created a shift in cirrhosis management.Various causes,including hepatitis viruses,alcohol consumption,and fatty liver disease,contribute to cirrhosis and are closely linked to liver cancer.The disease develops through hepatocyte necrosis and regeneration,resulting in fibrosis and sinusoidal capillarization,leading to portal hypertension and complications such as ascites,hepatic encephalopathy,and organ dysfunction.Cirrhosis also holds an increased risk of hepatocellular carcinoma.Diagnosing cirrhosis involves assessing fibrosis scores through blood tests and measuring liver stiffness through elastography.Liver transplantation is the definitive treatment for endstage liver disease and acute liver failure.展开更多
Objective:While albumin and the weight-standardized hand grip strength(HGS/W)serve as valuable prognostic indicators for cancer patients,their correlation with the prognosis in frail cancer patients remains inadequate...Objective:While albumin and the weight-standardized hand grip strength(HGS/W)serve as valuable prognostic indicators for cancer patients,their correlation with the prognosis in frail cancer patients remains inadequately explored.This study aimed to investigate the prognostic importance of the albumin level and HGS/W in cancer patients with frailty and to further investigate their combined prognostic value.Moreover,this comprehensive evaluation aimed to facilitate timely intervention and treatment for frail patients.Methods:The research enrolled 5,794 cancer patients identified with frailty from a multicenter research database.The diagnosis of frailty was based on the FRAIL scale.An Albumin-HGS/W score was constructed by combining the albumin and HGS/W values.Cox proportional hazard regression was utilized to examine the association between the albumin level and HGS/W and patient outcomes.Results:Among these patients,2,543 were females and 3,251 were males,with a median age of 60.0 years.Optimal stratification based on patient survival revealed the ideal threshold for HGS/W to be 0.48 for males and 0.39 for females,and for albumin to be 38 for both sexes.The fully adjusted model revealed that higher Albumin-HGS/W scores were correlated with a poorer patient prognosis.Notably,an Albumin-HGS/W score of 2 was associated with a higher risk of mortality compared with a score of 0 in the total population(HR:1.813,95%CI:1.580-2.080,P<0.001).Conclusions:Low albumin or HGS/W values are associated with low survival in cancer patients with frailty.Elevated Albumin-HGS/W scores were linked to decreased survival rates in cancer patients with frailty.展开更多
Objective As populations age,multimorbidity and frailty have emerged as major health challenges.While their associations with disability and mortality are well documented,their impact on quality of life(QoL)in sub-Sah...Objective As populations age,multimorbidity and frailty have emerged as major health challenges.While their associations with disability and mortality are well documented,their impact on quality of life(QoL)in sub-Saharan Africa remains underexplored.We examined the associations between frailty,multimorbidity and QoL among older adults in Rwanda.Design A cross-sectional population-based study.Multimorbidity was defined as having two or more chronic conditions,including hypertension,diabetes,heart disease and mental health conditions.Frailty scores were derived using the Fried phenotype,and QoL was measured using the European Health Instrument Survey-Quality of Life index(scaled 0%–100%).Sequential linear regression models were used to examine independent associations.Setting Rural and urban settings of Rwanda.Participant We analysed data from 4369 adults(≥40 years).Results The mean QoL score was 48.2%(±15.6).Frailty and multimorbidity prevalence were 14.5%(95%CI 13.5 to 15.6)and 55.2%(95%CI 53.7 to 56.6),respectively,while 55.0%(95%CI 53.3 to 56.3)were classified as prefrail.Frailty and multimorbidity are independently associated with poorer QoL.Compared with robust individuals,prefrail and frail individuals experienced a 3.66(95%CI−4.63 to–2.70)and 7.30(95%CI−8.76 to–5.83)percentage point reduction in QoL,respectively.Multimorbidity was associated with a 4.66%(95%CI−5.54 to–3.79)point decrease in QoL.Impairments in activities of daily living partly mediated these associations.Conclusions Frailty and multimorbidity showed a strong negative association with QoL,with frailty having a stronger effect.These findings underscore the need for age-responsive healthcare strategies,including frailty screening and integrated chronic care,to enhance QoL among older adults in Rwanda.展开更多
BACKGROUND Heart failure with preserved ejection fraction(HFpEF)following acute myocardial infarction(AMI)carries substantial morbidity and mortality,yet reliable prognostic markers beyond conventional cardiovascular ...BACKGROUND Heart failure with preserved ejection fraction(HFpEF)following acute myocardial infarction(AMI)carries substantial morbidity and mortality,yet reliable prognostic markers beyond conventional cardiovascular factors remain limited.Frailty,reflecting diminished physiological reserve,has emerged as a potential determinant of adverse outcomes in this high-risk population.Therefore,the aim of this study was to address a critical knowledge gap and to provide evidence that may guide frailty-adapted management strategies to improve prognosis and quality of life in this high-risk population.METHODS We conducted a multicenter retrospective cohort study including 4507 patients with HFpEF discharged after AMI across 82 hospitals in China(from January 2010 to March 2024).Frailty was assessed using the Hospital Frailty Risk Score(HFRS),with HFRS<5 defined as non-frail and HFRS≥5 as frail.Multivariable Cox proportional hazards models,adjusted for demographics,comorbidities,left ventricular ejection fraction,and therapies,were applied to evaluate associations between frailty and clinical outcomes.The primary endpoints were all-cause death and major adverse cardiovascular events(MACE),which defined as the composite of cardiovascular death and heart failure rehospitalization.Secondary endpoints included net adverse clinical events(NACE),which defined as the composite of all-cause death,stroke,recurrent myocardial infarction,revascularization,and major bleeding,as well as the individual components of MACE.RESULTS Frailty was independently associated with a higher risk of all-cause death[adjusted hazard ratio(aHR)=1.52,95%CI:1.31–2.03,P=0.005]and NACE(aHR=1.20,95%CI:1.02–1.41,P=0.026).At one year,frail patients had higher unadjusted rates of all-cause death(9.0%vs.2.9%)and NACE(19.8%vs.13.7%)compared with non-frail patients.For cardiovascular death,the association did not reach statistical significance(aHR=1.42,95%CI:0.99–2.03,P=0.053).No significant associations were found for MACE(aHR=1.05,95%CI:0.86–1.28,P=0.636)or heart failure rehospitalization(aHR=0.94,95%CI:0.75–1.19,P=0.616).CONCLUSIONS Frailty,as measured by the HFRS,is an independent predictor of one-year mortality and composite adverse events in post-AMI HFpEF patients.These findings support the use of HFRS at discharge to identify high-risk population who may benefit from closer follow-up,optimization of medical therapy,and targeted frailty-focused interventions.展开更多
Total hip arthroplasty(THA)effectively treats advanced hip disorders,yet outcomes vary among patients.Frailty has become a crucial factor influencing these results.Several studies explored multiple preoperative factor...Total hip arthroplasty(THA)effectively treats advanced hip disorders,yet outcomes vary among patients.Frailty has become a crucial factor influencing these results.Several studies explored multiple preoperative factors affecting THA outcomes,highlighting the significance of age,Western Ontario and Mc-Master Universities Osteoarthritis Index,Center for Epidemiologic Studies Depression Scale,and central sensitization index scores in predicting post-operative recovery,emphasizing comprehensive preoperative assessments.Subsequent research has shown that frailty,measured by tools like the hospital frailty risk score and frailty deficit index,is significantly associated with adverse outcomes such as higher 30-day readmission rates,longer hospital stays,increased costs,and elevated mortality and complication risks in both primary and revision THA.Additionally,frailty related to short-term adverse events but stressed the need for standardized frailty measurement.Currently,there is no unified standard for assessing frailty before THA,which hinders cross-study comparison and evidence-based guideline development.Future research should focus on establishing a universal frailty assessment standard considering physical function,comorbidities,cognitive and psychological status.Prospective studies are also needed to clarify the causal relationship between frailty and long-term THA outcomes and identify modifiable factors for preoperative interventions.Overall,understanding the impact of frailty on THA outcomes is essential for improving patient care and resource utilization,especially in an aging population with a rising prevalence of hip disorders.展开更多
Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by re...Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging,which significantly complicates their recovery process.To date,no study has investigated burns as a potential risk factor for frailty.This study aimed to determine the short-term prevalence of frailty among burn survivors’months after injury and compare it with that of the general population.Methods:A post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury(RE-ENERGIZE)trial,an international randomized-controlled trial involving 1200 burn injury patients with partial-or full-thickness burns.Participants who did not complete the 36-Item Short Form Health Survey(SF-36)questionnaire were excluded.Data for the general population were obtained from the 2022 National Health Interview Survey(NHIS).Frailty was assessed using the FRAIL(Fatigue,Resistance,Ambulation,Illness,Loss of weight)scale.Due to lack of data on loss of weight,for the purposes of this study,malnutrition was used as the fifth variable.Illness and malnutrition were based on admission data,while fatigue,resistance,and ambulation were determined from post-discharge responses to the SF-36.The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status.Within the burn group,patients were divided into different subgroups based on their frailty status,and the differences in their(instrumental)activities of daily living(iADL and ADL)were compared.A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL.Results:Out of the 1200 burn patients involved in the study,600 completed the required questionnaires[follow-up time:(5.5±2.3)months]and were matched to 1200 adults from the general population in the U.S.In comparison to the general population,burn patients exhibited a significantly higher likelihood of being pre-frail(42.3%vs.19.8%,P<0.0001),or frail(13.0%vs.1.0%,P<0.0001).When focusing on specific components,burn patients were more prone to experiencing fatigue(25.8%vs.13.5%,P<0.0001),limited resistance(34.0%vs.2.7%,P<0.0001),and restricted ambulation(41.8%vs.3.8%,P<0.0001).Conversely,the incidence rate of illness was observed to be higher in the general population(1.2%vs.2.8%,P=0.03),while no significant difference was detected regarding malnutrition(2.3%vs.2.6%,P=0.75).Furthermore,in comparison with robust burn patients,it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL.The frail cohort reported the most pronounced limitation.Conclusions:Our findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury.Burn survivors experience compromised fatigue,resistance,and ambulation,while rates of illness and malnutrition were lower or unchanged,respectively.These results underscore the critical need for early identification of frailty after a burn injury,with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists,community physicians,physiotherapists,nutritionists,and social workers.This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.展开更多
Background1 Currently,there is a scarcity of risk prediction models for frailty in hospitalized patients with chronic heart failure(CHF).This study aimed to investigate the frailty status of hospitalized CHF patients,...Background1 Currently,there is a scarcity of risk prediction models for frailty in hospitalized patients with chronic heart failure(CHF).This study aimed to investigate the frailty status of hospitalized CHF patients,identify independent risk factors significantly associated with frailty,and construct an effective risk prediction model.The goal was to provide a reference for clinical strategies in preventing and managing frailty among CHF patients.Methodss Using convenience sampling,we enrolled 184 hospitalized CHF patients from a tertiary hospital between February 2022 and December 2024.General demographic data were collected via questionnaires,alongside frailty screening using the FRAIL scale and assessment of daily functioning with the Activities of Daily Living(ADL)scale.Clinical data were obtained by reviewing medical records.Participants were categorized into a frail group(n=65)and a non-frail group(n=119)based on frailty status.Clinical risk factors were compared between groups.Multivariate logistic regression was used to identify independent risk factors.A prediction model was constructed,and a receiver operating characteristic(ROC)curve was plotted to evaluate its predictive value.Results A total of 184 hospitalized CHF patients were included,with 65(35.33%)exhibiting frailty.Multivariate logistic regression analysis showed that independent risk factors for frailty included:age,ADL score,N-terminal pro-brain natriuretic peptide(NT-pro-BNP),left ventricular ejection fraction(LVEF),New York Heart Association(NYHA)class II/IV,≥3 comorbidities,comorbid diabetes mellitus(DM),comorbid valvular heart disease(VHD),smoking history,hemoglobin(Hb),albumin,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),creatinine(Cr),and blood urea nitrogen(BUN).The aforementioned factors were incorporated into logistic regression analysis and the prediction model was built.The prediction model showed quite strong predictive performance.Its area under the ROC curve was 0.904(95%CI:0.857-0.951),with a sensitivity of98.5%and a specificity of 85.7%.ConclusionssThe frailty risk prediction model for hospitalized CHF patients demonstrated robust discriminative ability and calibration.It provided substantial reference value for clinical management of CHF,offering a basis for early assessment,risk stratification,and targeted interventions to prevent frailty by identifying high-risk patients.展开更多
文摘Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018–2021.Methods This was an ambispective cohort study. A total of 85 older adults participating in the Chronic Heart Failure Program at Guillermo Almenara National Hospital were included. Each had an initial frailty assessment, forming two cohorts: frail and non-frail older adults. Medical records were reviewed, and patients were followed for one year to track events of interest(hospitalization and mortality). Overall survival and risk factors for hospitalization and death were determined.Results During follow-up, 15.3% of the older adults died, and frailty was identified in 58.8% of the patients. Overall survival using the Kaplan-Meier method was 96.5% at 3 months after entering the Chronic Heart Failure Program;92.9% at 6 months;and85.9% at one year. Multivariate analysis using Poisson regression found that frailty was not a risk factor for hospitalization(a RR =0.92;95% CI: 0.42–2.03). Survival analysis using the Cox proportional hazards model showed that frailty was also not a risk factor for mortality after one year of follow-up(a HR = 1.32;95% CI: 0.27–6.53).Conclusions Our research does not confirm frailty as a risk factor for hospitalization or mortality in older adults enrolled in the“Chronic Heart Failure Program” after one year of follow-up.
文摘Background Frailty is common and significantly impacts prognosis in heart failure(HF). The Vulnerable Elders Survey-13(VES-13), widely used in oncogeriatrics and public health, remains unexplored as a frailty screening tool in HF outpatients. In this study, we prospectively evaluated VES-13 against a multimodal screening assessment in detecting frailty and predicting individual risk of adverse prognosis.Methods Frailty was assessed at the initial visit using both a multimodal approach, incorporating Barthel Index, Older American Resources and Services scale, Pfeiffer Test, abbreviated Geriatric Depression Scale, age > 85 years, lacking support systems,and VES-13. Patients scoring ≥ 3 on VES-13 or meeting at least one multimodal criterion were classified as frail. Endpoints included all-cause mortality, a composite of death or HF hospitalization, and recurrent HF hospitalizations.Results A total of 301 patients were evaluated. VES-13 identified 40.2% as frail and the multimodal assessment 33.2%. In Cox regression analyses, frailty identified by VES-13 showed greater prognostic significance than the multimodal assessment for allcause mortality(HR = 3.70 [2.15–6.33], P < 0.001 vs. 2.40 [1.46–4.0], P = 0.001) and the composite endpoint(HR = 3.13 [2.02–4.84], P< 0.001 vs. 1.96 [1.28–2.99], P = 0.002). Recurrent HF hospitalizations were four times more frequent in VES-13 frail patients while two times in those identified as frail by the multimodal assessment. Additionally, stratifying patients by VES-13 tertiles provided robust risk differentiation.Conclusions VES-13, a simple frailty tool, outperformed a comprehensive multimodal assessment and could be easily integrated into routine HF care, highlighting its clinical utility in identifying patients at risk for poor outcomes.
文摘Frailty is a geriatric syndrome characterized by a reduced ability to maintain homeostasis due to age-related declines in physiological reserves.It increases the risk of adverse health outcomes such as falls,hospitalization,disability,and mortality,especially in older adults.Key risk factors for frailty include cancer,chronic obstructive pulmonary disease,and cerebrovascular disease.Several models of frailty exist,including the physical frailty phenotype,the deficit accu-mulation model,and mixed physical-psychosocial models.Numerous tools are available for assessment.Cognitive dysfunction is closely related to frailty,sharing underlying mechanisms such as oxidative stress,inflammation,and vascular pathologies.Additionally,social frailty,which can be exacerbated by isolation and limited social support,further complicates the challenges faced by frail individuals.It is recommended that frailty screening,particularly through gait speed assessment,can be conducted in primary healthcare settings.Despite existing guidelines,there is still no consensus on the definition,screening,and diagnosis of frailty.This emphasizes the necessity for additional research to conduct a conceptual diagnosis and screen the older population.Artificial intel-ligence approaches show promise in identifying frail patients and managing their care.
文摘BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.
文摘BACKGROUND Non-ST-elevation myocardial infarction(NSTEMI)is a prevalent acute coronary syndrome among the elderly,a population often underrepresented in clinical trials.Frailty,a marker of physiologic vulnerability,may influence the risks and benefits of percutaneous coronary intervention(PCI)in these patients.AIM To evaluate the impact of frailty status on in-hospital outcomes among patients aged≥75 years with NSTEMI undergoing PCI.METHODS We conducted a retrospective cohort study using the 2021-2022 National Inpatient Sample to evaluate the impact of frailty on in-hospital outcomes among NSTEMI patients aged≥75 years undergoing PCI.Patients were stratified into three frailty categories using the Hospital Frailty Risk Score.Multivariable logistic and generalized linear models with interaction terms assessed the association between frailty and clinical outcomes.RESULTS Among 456690 NSTEMI admissions,37.95%,50.71%,and 11.34%were categorized as low,intermediate,and high frailty,respectively.PCI use declined with increasing frailty(35.0%in low vs 7.5%in high;P<0.001).Adjusted mortality was lower with PCI across all frailty levels[odds ratios(OR):0.27(low),0.37(intermediate),0.43(high);all P<0.001].However,the mortality benefit was attenuated with increasing frailty(interaction OR:1.56 and 1.83 for intermediate and high vs low frailty;P<0.001).Frailty was independently associated with higher odds of complications,including acute kidney injury,respiratory failure,delirium,and bleeding.PCI was associated with shorter hospital stays in low(-0.90 days)but longer in the high-frail category(+2.47 days;P<0.001),and increasing frailty correlated with significantly higher hospital charges.CONCLUSION In elderly NSTEMI patients,PCI conferred a survival benefit across all frailty strata,although with a diminishing magnitude as frailty increased.Frailty correlated with increased complications and healthcare resource utilization.
基金Natural Science Foundation of Shandong Province(Grant No.ZR2021QH176)。
文摘Background Cardiovascular disease(CVD)and frailty are interrelated conditions prevalent in aging populations,yet their dynamic temporal relationship remains underexplored.This study investigates longitudinal changes in frailty trajectories before and after incident CVD across diverse cohorts.Methods Utilizing data from four longitudinal,multinational cohorts(ELSA,HRS,CHARLS,SHARE;n=66,537),we constructed the frailty index(FI)based on age-related health deficits,using 40,40,42,and 44 items from ELSA,HRS,CHARLS and SHARE,respectively.Linear mixed models assessed FI changes pre-and post-CVD,adjusting for demographics,lifestyle,and baseline FI.Sensitivity analyses excluded hypertension,diabetes,and arthritis to mitigate confounding.Results Frailty increased steadily before CVD onset(pre-CVD slope:ELSAβ=0.005,HRSβ=0.005,CHARLSβ=0.012,SHAREβ=0.007;all P<0.001),with an acute FI spike at diagnosis(post-CVD acute change:ELSAβ=0.024,HRSβ=0.031,CHARLSβ=0.046,SHAREβ=0.038;all P<0.001).Post-CVD,frailty progression further accelerated(ELSAβ=0.008,HRSβ=0.005,CHARLSβ=0.017,SHAREβ=0.010;all P<0.001).Sensitivity analyses confirmed robustness across age strata and FI definitions.Conclusions This first multinational study demonstrates bidirectional acceleration of frailty around CVD onset,highlighting their close temporal interplay.These findings suggest that incorporating frailty assessment into CVD management may help identify high-risk individuals and support timely,multidimensional care in aging populations.
文摘Background Frailty is a major determinant of outcomes in patients with coronary artery disease(CAD)undergoing lower limb amputation.This study evaluates the impact of frailty on in-hospital outcomes in these patients.Methods We performed a retrospective analysis of the National Inpatient Sample(2016–2021)to identify adult patients with CAD who underwent lower limb amputation.Frailty was defined using the Johns Hopkins Adjusted Clinical Groups(ACG)frailty indicator.Multivariable logistic regression was used to assess the independent association of frailty with in-hospital outcomes,and propensity score matching(PSM)was performed to further account for confounding factors.Results After PSM,9,990 patients were included in each cohort.Frail patients experienced higher rates of in-hospital mortality(3.9%vs.1.5%,P<0.001),acute limb ischemia(3.8%vs.3.1%,P=0.015),fasciotomy(2.1%vs.1.4%,P<0.001),stump infection(7.9%vs.6.6%,P<0.001),cardiogenic shock(0.9%vs.0.7%,P=0.032),sudden cardiac arrest(2.7%vs.2.1%,P=0.004),mechanical circulatory support(0.3%vs.0.2%,P=0.028),major adverse cardiac and cerebrovascular events(7.7%vs.5.4%,P<0.001),and sepsis(18.3%vs.13.8%,P<0.001).In multivariable logistic regression analysis,frailty remained an independent predictor of inhospital mortality and major complications.Conclusion Frailty is independently associated with increased in-hospital mortality and adverse events among CAD patients undergoing lower limb amputation.Incorporating frailty assessment into preoperative evaluation may improve risk stratification and guide clinical decision-making in this high-risk population.
基金supported by the National Natural Science Foundation of China(82222064,81973147)the National Key Research and Development Program(2022YFC2010100)the Shandong University Distinguished Young Scholars。
文摘Objective Burning solid cooking fuel contributes to household air pollution and is associated with frailty.However,how solid cooking fuel use contributes to the development of frailty has not been well illustrated.Methods This study recruited 8,947 participants aged≥45 years from the China Health and Retirement Longitudinal Study,2011–2018.Group-based trajectory modeling was employed to identify frailty trajectories.Multinomial logistic regression was used to assess the association between solid cooking fuel use and frailty trajectories.Population-attributable fractions were used to estimate the frailty burden from solid fuel use.Results We identified three frailty trajectories:low-stable(n=5,789),moderate-increasing(n=2,603),and fast-increasing(n=555).Solid fuel use was associated with higher odds of being in the moderate-increasing(OR:1.24,95%CI:1.08–1.42)and fast-increasing(OR:1.48,95%CI:1.14–1.92)trajectories.These associations were strengthened by longer solid fuel use(P for trend<0.001).Switching to clean fuel significantly reduced the risk of being in these trajectories compared with persistent solid fuel users.Without solid fuel,8%of moderate-and 19%of fast-increasing trajectories demonstrated frailty development like the low-stable group.Conclusion Solid cooking fuel use is associated with frailty trajectories in middle-aged and older Chinese populations.
文摘Frailty has emerged as a pivotal determinant of post-liver transplant(LT)outcomes,yet its integration into clinical practice remains inconsistent.Defined by functional impairments and reduced physiologic reserve,frailty transcends traditional metrics like the model for end-stage liver disease(MELD)score,demonstrating increasing predictive value for mortality beyond the immediate postoperative period.Recent findings suggest that frail recipients experience significantly higher mortality within the first 12 months following transplantation—a period when traditional monitoring often wanes.This raises critical questions about the adequacy of current assessment and follow-up protocols.The observed dissociation between MELD scores and long-term survival underscores the limitations of existing selection criteria.Frailty,as a dynamic and modifiable condition,represents an opportunity for targeted intervention.Prehabilitation programs focusing on nutritional optimization,physical rehabilitation,and psychosocial support could enhance resilience in transplant candidates,reducing their risk profile and improving post-transplant outcomes.Furthermore,these findings call for an expanded approach to post-transplant monitoring.Extending surveillance for frail recipients beyond standard timelines may facilitate early detection of complications,mitigating their impact on survival.Incorporating frailty into both pre-and post-transplant protocols could redefine how transplant centers evaluate and manage risk.This editorial advocates for a paradigm shift:Frailty must no longer be viewed as a secondary consideration but as a core element in LT care.By addressing frailty comprehensively,we can move toward more personalized,effective strategies that improve survival and quality of life for LT recipients.
文摘Objectives:This study aimed to develop a mobile frailty management platform for Chinese communitydwelling older adults and evaluate its effectiveness,usability and safety.Methods:Based on literature research,the research team combined the frailty cycle and integration models,self-determination theory,and technology acceptance models and determined the frailty interventions through expert discussion,then transformed it into multimedia resources,finally,engineers developed the mobile management platform.A cluster sampling,parallel,single-blind,controlled quasiexperimental trial was conducted.Sixty older adults from two community health service centers were recruited from March to August 2023.The control group received routine community care,while the intervention group used the mobile frailty management platform.The incidence of frailty,scores of quality of life,depression,sleep quality,and grip strength within 12 weeks were compared between the two groups,and the availability and safety of the platform were assessed.Results:A total of 52 participants completed the study,27 in the intervention group and 25 in the control group.At 12 weeks after the intervention,the frailty state of the intervention group was reversed to prefrailty.There were no significant differences in the scores of quality of life,depression,sleep quality,and grip strength between the two groups before and 4 weeks after intervention.At 8 weeks and 12 weeks after the intervention,the quality of life,depression,and grip strength of the intervention group were improved with statistical significance(P<0.05).Sleep quality was statistically significant only 12 weeks after the intervention(P<0.05).System Usability Scale score for the platform was(87.96±5.88),indicating a highly satisfactory user experience.Throughout the intervention,no adverse events were reported among the older adults.Conclusions:The mobile frailty management platform effectively improved frailty status,depressive mood,sleep quality,grip strength,and quality of life for Chinese community-dwelling older adults.It holds clinical application value and is an effective tool for strengthening frailty management among Chinese community-dwelling older adults.
基金Supported by National High Level Hospital Clinical Research Funding Project,No.BJ-2023-206.
文摘This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.
基金supported by the National Key Research and Development Program of China(2017YFC0907004 to YZ)。
文摘Background Physical frailty and depression may share common pathophysiological pathways associated with dementia and thus interact with each other.However,previous studies have primarily focused on the individual impact of these factors on dementia.Aims To examine the joint effect and interaction of physical frailty and depression on the risk of all-cause dementia.Methods We conducted prospective analyses among participants aged≥60 years from three cohorts:the UK Biobank(UKB),the English Longitudinal Study of Ageing(ELSA)and the Health and Retirement Study(HRS).Physical frailty was assessed using modified versions of the Fried frailty phenotype.Depression was evaluated through mental health questionnaires or combined with hospital admission records.The primary outcome was incident all-cause dementia,identified via active follow-up and passive surveillance.Cox proportional hazards models were used to estimate the hazard ratios(HRs)and 95%confidence intervals(CIs).Results A total of 220947 participants(mean age:64.5 years;53.3%female)were included.Over 2832696 person-years of follow-up,9088 participants(7605 in UKB,1207 in HRS and 276 in ELSA)developed incident all-cause dementia.Compared with robust individuals,frail participants faced a 155%increased risk of dementia(pooled HR:2.55,95%CI 2.36 to 2.76;I2=72.3%).Depression conferred a 1.59-fold excess risk for dementia(pooled HR:1.59,95%CI 1.50 to 1.69;I2=56.8%).Adding physical frailty and depression to a traditional dementia risk model significantly improved prediction accuracy(all p-Δarea under the curve<0.05).Jointly,participants with both physical frailty and depression exhibited the highest dementia risk(pooled HR:3.23,95%CI 2.86 to 3.65;I2=41.6%)compared with those without physical frailty and depression.Moreover,a significant additive interaction between physical frailty and depression was observed(pooled relative excess risk due to interaction:0.38,95%CI 0.13 to 0.63),with 17.1%(95%CI 6.0%to 28.3%)of dementia risk attributed to their interactive effects.Conclusions Individuals with both physical frailty and depression had the highest risk of dementia.More importantly,these two factors interact in an additive manner,further amplifying dementia risk.
文摘Cirrhosis represents the end stage of chronic liver disease,significantly reducing life expectancy as it progresses from a compensated to a decompensated state,leading to serious complications.Recent improvements in medical treatment have created a shift in cirrhosis management.Various causes,including hepatitis viruses,alcohol consumption,and fatty liver disease,contribute to cirrhosis and are closely linked to liver cancer.The disease develops through hepatocyte necrosis and regeneration,resulting in fibrosis and sinusoidal capillarization,leading to portal hypertension and complications such as ascites,hepatic encephalopathy,and organ dysfunction.Cirrhosis also holds an increased risk of hepatocellular carcinoma.Diagnosing cirrhosis involves assessing fibrosis scores through blood tests and measuring liver stiffness through elastography.Liver transplantation is the definitive treatment for endstage liver disease and acute liver failure.
基金supported by a Henan Province Science and Technology Research Project(No.252102311033)the National Key Research and Development Program(No.2022YFC2009600 and No.2022YFC2009601).
文摘Objective:While albumin and the weight-standardized hand grip strength(HGS/W)serve as valuable prognostic indicators for cancer patients,their correlation with the prognosis in frail cancer patients remains inadequately explored.This study aimed to investigate the prognostic importance of the albumin level and HGS/W in cancer patients with frailty and to further investigate their combined prognostic value.Moreover,this comprehensive evaluation aimed to facilitate timely intervention and treatment for frail patients.Methods:The research enrolled 5,794 cancer patients identified with frailty from a multicenter research database.The diagnosis of frailty was based on the FRAIL scale.An Albumin-HGS/W score was constructed by combining the albumin and HGS/W values.Cox proportional hazard regression was utilized to examine the association between the albumin level and HGS/W and patient outcomes.Results:Among these patients,2,543 were females and 3,251 were males,with a median age of 60.0 years.Optimal stratification based on patient survival revealed the ideal threshold for HGS/W to be 0.48 for males and 0.39 for females,and for albumin to be 38 for both sexes.The fully adjusted model revealed that higher Albumin-HGS/W scores were correlated with a poorer patient prognosis.Notably,an Albumin-HGS/W score of 2 was associated with a higher risk of mortality compared with a score of 0 in the total population(HR:1.813,95%CI:1.580-2.080,P<0.001).Conclusions:Low albumin or HGS/W values are associated with low survival in cancer patients with frailty.Elevated Albumin-HGS/W scores were linked to decreased survival rates in cancer patients with frailty.
文摘Objective As populations age,multimorbidity and frailty have emerged as major health challenges.While their associations with disability and mortality are well documented,their impact on quality of life(QoL)in sub-Saharan Africa remains underexplored.We examined the associations between frailty,multimorbidity and QoL among older adults in Rwanda.Design A cross-sectional population-based study.Multimorbidity was defined as having two or more chronic conditions,including hypertension,diabetes,heart disease and mental health conditions.Frailty scores were derived using the Fried phenotype,and QoL was measured using the European Health Instrument Survey-Quality of Life index(scaled 0%–100%).Sequential linear regression models were used to examine independent associations.Setting Rural and urban settings of Rwanda.Participant We analysed data from 4369 adults(≥40 years).Results The mean QoL score was 48.2%(±15.6).Frailty and multimorbidity prevalence were 14.5%(95%CI 13.5 to 15.6)and 55.2%(95%CI 53.7 to 56.6),respectively,while 55.0%(95%CI 53.3 to 56.3)were classified as prefrail.Frailty and multimorbidity are independently associated with poorer QoL.Compared with robust individuals,prefrail and frail individuals experienced a 3.66(95%CI−4.63 to–2.70)and 7.30(95%CI−8.76 to–5.83)percentage point reduction in QoL,respectively.Multimorbidity was associated with a 4.66%(95%CI−5.54 to–3.79)point decrease in QoL.Impairments in activities of daily living partly mediated these associations.Conclusions Frailty and multimorbidity showed a strong negative association with QoL,with frailty having a stronger effect.These findings underscore the need for age-responsive healthcare strategies,including frailty screening and integrated chronic care,to enhance QoL among older adults in Rwanda.
基金supported by the Tianjin Key Medical Discipline(Specialty)Construction Project(TJYXZDXK-029A)the Key Project of Tianjin Natural Science Foundation(21JCZDJC01080)the Tianjin Fourth Central Hospital Outstanding Young Talent Fund(tjdszxyy20230008).
文摘BACKGROUND Heart failure with preserved ejection fraction(HFpEF)following acute myocardial infarction(AMI)carries substantial morbidity and mortality,yet reliable prognostic markers beyond conventional cardiovascular factors remain limited.Frailty,reflecting diminished physiological reserve,has emerged as a potential determinant of adverse outcomes in this high-risk population.Therefore,the aim of this study was to address a critical knowledge gap and to provide evidence that may guide frailty-adapted management strategies to improve prognosis and quality of life in this high-risk population.METHODS We conducted a multicenter retrospective cohort study including 4507 patients with HFpEF discharged after AMI across 82 hospitals in China(from January 2010 to March 2024).Frailty was assessed using the Hospital Frailty Risk Score(HFRS),with HFRS<5 defined as non-frail and HFRS≥5 as frail.Multivariable Cox proportional hazards models,adjusted for demographics,comorbidities,left ventricular ejection fraction,and therapies,were applied to evaluate associations between frailty and clinical outcomes.The primary endpoints were all-cause death and major adverse cardiovascular events(MACE),which defined as the composite of cardiovascular death and heart failure rehospitalization.Secondary endpoints included net adverse clinical events(NACE),which defined as the composite of all-cause death,stroke,recurrent myocardial infarction,revascularization,and major bleeding,as well as the individual components of MACE.RESULTS Frailty was independently associated with a higher risk of all-cause death[adjusted hazard ratio(aHR)=1.52,95%CI:1.31–2.03,P=0.005]and NACE(aHR=1.20,95%CI:1.02–1.41,P=0.026).At one year,frail patients had higher unadjusted rates of all-cause death(9.0%vs.2.9%)and NACE(19.8%vs.13.7%)compared with non-frail patients.For cardiovascular death,the association did not reach statistical significance(aHR=1.42,95%CI:0.99–2.03,P=0.053).No significant associations were found for MACE(aHR=1.05,95%CI:0.86–1.28,P=0.636)or heart failure rehospitalization(aHR=0.94,95%CI:0.75–1.19,P=0.616).CONCLUSIONS Frailty,as measured by the HFRS,is an independent predictor of one-year mortality and composite adverse events in post-AMI HFpEF patients.These findings support the use of HFRS at discharge to identify high-risk population who may benefit from closer follow-up,optimization of medical therapy,and targeted frailty-focused interventions.
基金Supported by the Natural Science Foundation Project of the Science and Technology Bureau of Yuzhong District,Chongqing,No.20240129.
文摘Total hip arthroplasty(THA)effectively treats advanced hip disorders,yet outcomes vary among patients.Frailty has become a crucial factor influencing these results.Several studies explored multiple preoperative factors affecting THA outcomes,highlighting the significance of age,Western Ontario and Mc-Master Universities Osteoarthritis Index,Center for Epidemiologic Studies Depression Scale,and central sensitization index scores in predicting post-operative recovery,emphasizing comprehensive preoperative assessments.Subsequent research has shown that frailty,measured by tools like the hospital frailty risk score and frailty deficit index,is significantly associated with adverse outcomes such as higher 30-day readmission rates,longer hospital stays,increased costs,and elevated mortality and complication risks in both primary and revision THA.Additionally,frailty related to short-term adverse events but stressed the need for standardized frailty measurement.Currently,there is no unified standard for assessing frailty before THA,which hinders cross-study comparison and evidence-based guideline development.Future research should focus on establishing a universal frailty assessment standard considering physical function,comorbidities,cognitive and psychological status.Prospective studies are also needed to clarify the causal relationship between frailty and long-term THA outcomes and identify modifiable factors for preoperative interventions.Overall,understanding the impact of frailty on THA outcomes is essential for improving patient care and resource utilization,especially in an aging population with a rising prevalence of hip disorders.
基金supported by the U.S.Department of Defense(W81XWH-09-2-0194 for the pilot phase)the Canadian Institutes of Health Research(MCT-94834 for the pilot phase and 14238 for the definitive phase).
文摘Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging,which significantly complicates their recovery process.To date,no study has investigated burns as a potential risk factor for frailty.This study aimed to determine the short-term prevalence of frailty among burn survivors’months after injury and compare it with that of the general population.Methods:A post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury(RE-ENERGIZE)trial,an international randomized-controlled trial involving 1200 burn injury patients with partial-or full-thickness burns.Participants who did not complete the 36-Item Short Form Health Survey(SF-36)questionnaire were excluded.Data for the general population were obtained from the 2022 National Health Interview Survey(NHIS).Frailty was assessed using the FRAIL(Fatigue,Resistance,Ambulation,Illness,Loss of weight)scale.Due to lack of data on loss of weight,for the purposes of this study,malnutrition was used as the fifth variable.Illness and malnutrition were based on admission data,while fatigue,resistance,and ambulation were determined from post-discharge responses to the SF-36.The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status.Within the burn group,patients were divided into different subgroups based on their frailty status,and the differences in their(instrumental)activities of daily living(iADL and ADL)were compared.A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL.Results:Out of the 1200 burn patients involved in the study,600 completed the required questionnaires[follow-up time:(5.5±2.3)months]and were matched to 1200 adults from the general population in the U.S.In comparison to the general population,burn patients exhibited a significantly higher likelihood of being pre-frail(42.3%vs.19.8%,P<0.0001),or frail(13.0%vs.1.0%,P<0.0001).When focusing on specific components,burn patients were more prone to experiencing fatigue(25.8%vs.13.5%,P<0.0001),limited resistance(34.0%vs.2.7%,P<0.0001),and restricted ambulation(41.8%vs.3.8%,P<0.0001).Conversely,the incidence rate of illness was observed to be higher in the general population(1.2%vs.2.8%,P=0.03),while no significant difference was detected regarding malnutrition(2.3%vs.2.6%,P=0.75).Furthermore,in comparison with robust burn patients,it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL.The frail cohort reported the most pronounced limitation.Conclusions:Our findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury.Burn survivors experience compromised fatigue,resistance,and ambulation,while rates of illness and malnutrition were lower or unchanged,respectively.These results underscore the critical need for early identification of frailty after a burn injury,with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists,community physicians,physiotherapists,nutritionists,and social workers.This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.
基金supported by Guangdong Medical Science and Technology Research Fund Project(No.A2022458)Guangdong Provincial People's Medical Climbing Plan(Nursing Research Project)(No.DFJH2020011)。
文摘Background1 Currently,there is a scarcity of risk prediction models for frailty in hospitalized patients with chronic heart failure(CHF).This study aimed to investigate the frailty status of hospitalized CHF patients,identify independent risk factors significantly associated with frailty,and construct an effective risk prediction model.The goal was to provide a reference for clinical strategies in preventing and managing frailty among CHF patients.Methodss Using convenience sampling,we enrolled 184 hospitalized CHF patients from a tertiary hospital between February 2022 and December 2024.General demographic data were collected via questionnaires,alongside frailty screening using the FRAIL scale and assessment of daily functioning with the Activities of Daily Living(ADL)scale.Clinical data were obtained by reviewing medical records.Participants were categorized into a frail group(n=65)and a non-frail group(n=119)based on frailty status.Clinical risk factors were compared between groups.Multivariate logistic regression was used to identify independent risk factors.A prediction model was constructed,and a receiver operating characteristic(ROC)curve was plotted to evaluate its predictive value.Results A total of 184 hospitalized CHF patients were included,with 65(35.33%)exhibiting frailty.Multivariate logistic regression analysis showed that independent risk factors for frailty included:age,ADL score,N-terminal pro-brain natriuretic peptide(NT-pro-BNP),left ventricular ejection fraction(LVEF),New York Heart Association(NYHA)class II/IV,≥3 comorbidities,comorbid diabetes mellitus(DM),comorbid valvular heart disease(VHD),smoking history,hemoglobin(Hb),albumin,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),creatinine(Cr),and blood urea nitrogen(BUN).The aforementioned factors were incorporated into logistic regression analysis and the prediction model was built.The prediction model showed quite strong predictive performance.Its area under the ROC curve was 0.904(95%CI:0.857-0.951),with a sensitivity of98.5%and a specificity of 85.7%.ConclusionssThe frailty risk prediction model for hospitalized CHF patients demonstrated robust discriminative ability and calibration.It provided substantial reference value for clinical management of CHF,offering a basis for early assessment,risk stratification,and targeted interventions to prevent frailty by identifying high-risk patients.
