A multicomponent de-frailing intervention for hospitalized cardiac patients
Notice bibliographique
Résumé
Background: The aging population presents increasing challenges for healthcare professionals to treat patients in the context of both health and function. Frailty is a reversible geriatric syndrome, which refers to the body’s inability to maintain homeostasis in the face of stressors and increases risk for the development of adverse health outcomes or death. Patients with cardiovascular disease (CVD), one of the top causes of death worldwide, are disproportionately impacted by frailty. Hospitalization itself is an important stressor that may lead to the exacerbation or development of frailty due to factors such as bedrest, undernutrition, cognitive stress, and frequent tests/procedures. The purpose of this thesis is to review the literature to understand pathophysiological connections between frailty and CVD and to assess the existing interventions for de-frailing hospitalized older adults with CVD, and to present the results of a randomized clinical trial assessing a novel technique to treat frailty in CVD inpatients.Methods: A literature review was performed on the pathophysiological connections between frailty and CVD, as well as to review existing hospital interventions to treat frailty in CVD patients. Subsequently, a randomized clinical trial (TARGET-EFT) was conducted in the acute cardiology ward at the Jewish General Hospital (Montreal, Canada) to test the effect of a targeted multicomponent de-frailing intervention in hospitalized older adults with CVD. The intervention consisted of physical exercise, cognitive stimulation, protein supplementation and anemia correction. The control group received usual clinical care. Outcomes of interest were physical frailty and functional status at discharge from the hospital and 30 days later, measured using the Short Physical Performance Battery (SPPB) and the SARC-F sarcopenia/strength questionnaire.Results: TARGET-EFT was the first trial to study and successfully de-frail older adults hospitalized with CVD. The analysis consisted of n=135 patients (n=66 in the intervention group and n=69 in the control group), with a mean age of 79.3 ± 7.7 years and 54% females, who survived and completed the frailty assessments. The average post-randomization length of stay of patients was 11.0 ± 11.7 days, and the most common reasons for admission were evenly distributed between ischemic heart disease and heart failure, followed by arrhythmia and valvular heart disease. Patients in the intervention group showed a significant 1.52-point improvement in the SPPB at discharge and maintained these benefits in a short-term follow-up 30 days later, as evidenced by a significant 0.74-point improvement in the SARC-F questionnaire. There were no intervention-related adverse events. Subgroup analyses demonstrated that patients with low left ventricular ejection fraction had significantly attenuated benefits, and patients who underwent invasive cardiac procedures derived significantly greater benefits from the intervention.Conclusions: Our multi-component de-frailing intervention with physical, cognitive, nutritional and anemia components was safe and feasible for hospitalized CVD patients. Furthermore, the intervention led to clinically meaningful improvements in frailty and physical function. The integration of this intervention into usual clinical care is expected to lead to subsequent improvements in the post-hospitalization quality of life of cardiac patients
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».