The "Heart Valve Clinic" Pathway for the Management of Frail Patients with Valvular Heart Disease: From "One for All" to "All for One"

Piergiorgio Bruno, Emanuele Marzetti, Francesco Burzotta, Massimo Massetti, Natalia Pavone, Claudio Spalletta, Marialisa Nesta, Andrea Mazzari, Christian Colizzi, Annalisa Pasquini

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Valvular heart disease (VHD) is frequently diagnosed in old patients with clinical evidence of heart failure. This elderly population typically presents a high prevalence of frailty and comorbidities, which are associated with increased operative risk for surgical and percutaneous procedures. Recently, the Euro Heart Survey reported a clear gap between treatment guidelines and their application in the "real world". A more realistic approach to the treatment of older VHD patients treatment, mostly if associated with heart failure, is advocated. A multidisciplinary approach, as obtained with the Heart Valve Clinic methodology (intended to put the patient in the "center" of the scene and the specialists "around him"), has been applied in a group of 79 patients, aged >70 years, with symptomatic VHD, divided in 2 groups according to their frailty status (58 robust and 21 frail). No in-hospital mortality and no difference in late mortality and complications were observed. Infections were more frequent (14.3 vs. 1.7 %; P = 0.02) in frail patients. In patients with postoperative complications, serum levels of interleukin 6 (67.6 vs. 49.6; P = 0.01) and of CAF (C-terminal agrin fragment) as sarcopenia marker (67.9 vs. 62.0; P = 0.04) were higher than that in uncomplicated patients. This study was designed to determine the outcomes of the multidimensional geriatric assessment in the management of older patients with heart failure eligible for heart valve surgery. Geriatric assessment and measurement of inflammatory and sarcopenia markers may represent valid tools for a more realistic evaluation of elderly patients with VHD.
Lingua originaleEnglish
pagine (da-a)61-65
Numero di pagine5
RivistaCritical Pathways in Cardiology
Volume18
DOI
Stato di pubblicazionePubblicato - 2019

Keywords

  • clinical pathway
  • frailty
  • heart failure
  • heart valve disease

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