The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior o...The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior of some tumors changes with age and the aging process itself brings physiological changes leading to decline in the function of organs. It is essential to identify those patients with longer life expectancy, potentially more likely to benefit from aggressive treatment vs. those that are more vulnerable to adverse outcomes. A primary determination when considering therapy for an older cancer patient is a patient's physiologic, rather than chronologic age. In order to differentiate amongst patients of the same age, it is useful to determine if a patient is fit or frail. Frail older adults have multiple chronic conditions and difficulties maintaining independence. They may be more vulnerable to therapy toxicities, and may not have substantial lasting benefits from therapy. Geriatric assessment(GA) may be used as a tool to determine reversible deficits and devise treatment strategies to mitigate such deficits. GA is also used in treatment decision making by clinicians, helping to risk stratify patients prior to potentially high-risk therapy. An important practical aspect of GA is the feasibility of incorporating it into a busy oncology practice. Key considerations in performing the GA include: available resources, patient population, GA tools to use, and who will be responsible for using the GA results and develop care plans. Challenges in implementing GA in clinical practice will be discussed.展开更多
Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAV...Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAVI).Their efforts underscore the growing importance of frailty assessment in cardiovascular risk stratification.We would like to respectfully highlight several areas that,if addressed in future studies(Figure 1),could further enhance the utility and inclusivity of these assessments.展开更多
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
Objective To assess the frailty status of patients with heart failure undergoing CRT-D and then explore the predictive value of frailty for all-cause mortality and heart failure-related readmissions in these patients....Objective To assess the frailty status of patients with heart failure undergoing CRT-D and then explore the predictive value of frailty for all-cause mortality and heart failure-related readmissions in these patients.Methods We retrospectively included 374 patients with chronic heart failure who underwent CRT-D treatment at the First Affiliated Hospitalof Xinjiang NMedical University between June 2020 and June 2024.Based on the Tilburg Debilitation Assessment Scale,175 patients(46.8%)were classified as frail while 199(53.2%)were classified as non-frail.The baseline data between the two groups was compared using Cox regression analysis and Kaplan-Meier curveswere used for survival analysis.P-values of<0.05 indicated statistically significant differences.Results A total of 374 patients aged 25-93(68±11)years were enrolled in this study,101(27.0%)of whom were female.Among these,175(46.8%)were categorized as frail,and 199(53.2%)were classified as non-frail.Over a median follow-up time of 23(5,45)months,35(9.4%)patients experienced all-cause mortality,with 30(17.1%)deaths occurring in the frail group and 5(2.5%)in the non-frail group;meanwhile,readmission events due to heart failure occurred in a total of 174(46.5%)patients,including 122(70.1%)in the frail group,and 52(29.9%)in the non-frail group.Cox analysis showed that frailty was a significant determinant of all-cause mortality(HR=21.25,95%CI 3.99-113.30,P<0.001)and readmission among heart failure patients receiving CRT-D(HR=2.52,95%CI 1.73-3.68,P<0.001).Log-rank tests showed that the survival rate of patients in the frail group was significantly lower than that of patients in the non-frail group(HR=7.22,95%CI 2.80-18.60,P<0.001)and the risk of readmission events due to heart failure was significantly higher among patients in the frail group than among those in the non-frail group(HR=2.75,95%CI 1.98-3.81,P<0.001).Conclusion Frailty is an independent predictor of postoperative all-cause mortality and the occurrenceof heart failure-related readmissions in patients with heart failure receiving CRT-D.展开更多
基金supported in part by Beatrice & Samuel A Seaver Foundationby the Memorial Sloan Kettering Cancer and Aging Research Program
文摘The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior of some tumors changes with age and the aging process itself brings physiological changes leading to decline in the function of organs. It is essential to identify those patients with longer life expectancy, potentially more likely to benefit from aggressive treatment vs. those that are more vulnerable to adverse outcomes. A primary determination when considering therapy for an older cancer patient is a patient's physiologic, rather than chronologic age. In order to differentiate amongst patients of the same age, it is useful to determine if a patient is fit or frail. Frail older adults have multiple chronic conditions and difficulties maintaining independence. They may be more vulnerable to therapy toxicities, and may not have substantial lasting benefits from therapy. Geriatric assessment(GA) may be used as a tool to determine reversible deficits and devise treatment strategies to mitigate such deficits. GA is also used in treatment decision making by clinicians, helping to risk stratify patients prior to potentially high-risk therapy. An important practical aspect of GA is the feasibility of incorporating it into a busy oncology practice. Key considerations in performing the GA include: available resources, patient population, GA tools to use, and who will be responsible for using the GA results and develop care plans. Challenges in implementing GA in clinical practice will be discussed.
文摘Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAVI).Their efforts underscore the growing importance of frailty assessment in cardiovascular risk stratification.We would like to respectfully highlight several areas that,if addressed in future studies(Figure 1),could further enhance the utility and inclusivity of these assessments.
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Objective To assess the frailty status of patients with heart failure undergoing CRT-D and then explore the predictive value of frailty for all-cause mortality and heart failure-related readmissions in these patients.Methods We retrospectively included 374 patients with chronic heart failure who underwent CRT-D treatment at the First Affiliated Hospitalof Xinjiang NMedical University between June 2020 and June 2024.Based on the Tilburg Debilitation Assessment Scale,175 patients(46.8%)were classified as frail while 199(53.2%)were classified as non-frail.The baseline data between the two groups was compared using Cox regression analysis and Kaplan-Meier curveswere used for survival analysis.P-values of<0.05 indicated statistically significant differences.Results A total of 374 patients aged 25-93(68±11)years were enrolled in this study,101(27.0%)of whom were female.Among these,175(46.8%)were categorized as frail,and 199(53.2%)were classified as non-frail.Over a median follow-up time of 23(5,45)months,35(9.4%)patients experienced all-cause mortality,with 30(17.1%)deaths occurring in the frail group and 5(2.5%)in the non-frail group;meanwhile,readmission events due to heart failure occurred in a total of 174(46.5%)patients,including 122(70.1%)in the frail group,and 52(29.9%)in the non-frail group.Cox analysis showed that frailty was a significant determinant of all-cause mortality(HR=21.25,95%CI 3.99-113.30,P<0.001)and readmission among heart failure patients receiving CRT-D(HR=2.52,95%CI 1.73-3.68,P<0.001).Log-rank tests showed that the survival rate of patients in the frail group was significantly lower than that of patients in the non-frail group(HR=7.22,95%CI 2.80-18.60,P<0.001)and the risk of readmission events due to heart failure was significantly higher among patients in the frail group than among those in the non-frail group(HR=2.75,95%CI 1.98-3.81,P<0.001).Conclusion Frailty is an independent predictor of postoperative all-cause mortality and the occurrenceof heart failure-related readmissions in patients with heart failure receiving CRT-D.
