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Journal articles on the topic 'Preoperative; Anesthesiologist; Cardiologist'

Author: Grafiati

Published: 4 June 2025

Last updated: 1 August 2025

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1

Ouattara, Alexandre, Michaëla Niculescu, Sarra Ghazouani, et al. "Predictive Performance and Variability of the Cardiac Anesthesia Risk Evaluation Score." Anesthesiology 100, no. 6 (2004): 1405–10. http://dx.doi.org/10.1097/00000542-200406000-00012.

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Background The Cardiac Anesthesia Risk Evaluation (CARE) score, a simple Canadian classification for predicting outcome after cardiac surgery, was evaluated in 556 consecutive patients in Paris, France. The authors compared its performance to those of two multifactorial risk indexes (European System for Cardiac Operative Risk Evaluation [EuroSCORE] and Tu score) and tested its variability between groups of physicians (anesthesiologists, surgeons, and cardiologists). Methods Each patient was simultaneously assessed using the three scores by an attending anesthesiologist in the immediate preoper

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Karim, Habib Md Reazaul. "Is majority of requests by anesthesiologists for cardiologist consultation unjustified?" Anaesthesia, Pain and Intensive Care 20, Suppl 1 (2016): S109 — S114. https://doi.org/10.5281/zenodo.2735046.

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ABSTRACT Preoperative consultation of a surgical patient by a cardiologist is intended to treat an inadequately treated cardiac condition before undergoing surgery. This can yield in terms of a new therapy, lead to optimization of the patients’ cardiac comorbidity, impact significantly in terms of perioperative management and potentially reduce postoperative adverse cardiac events. However, judicious use of preoperative consultation request is required both for avoiding unnecessary consultation, investigation and delay in proceeding with surgery as well as cost-effective health care deli

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McGahan, Rose K., Jonathan E. Tang, Manoj H. Iyer, Antolin S. Flores, and Leonid A. Gorelik. "Combined Liver Kidney Transplant in Adult Patient With Alagille Syndrome and Pulmonary Hypertension." Seminars in Cardiothoracic and Vascular Anesthesia 25, no. 3 (2021): 191–95. http://dx.doi.org/10.1177/10892532211008742.

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In this article, we describe a case of a 33-year-old female with Alagille syndrome complicated by bilateral branch pulmonary artery stenosis resulting in moderate pulmonary hypertension, end-stage liver disease complicated by portal hypertension, and chronic renal disease who presented for combined liver-kidney transplant. Alagille syndrome is an autosomal dominant disease affecting the liver, heart, and kidneys. Multidisciplinary preoperative evaluation was performed with a team consisting of a congenital heart disease cardiologist, a cardiac anesthesiologist, a nephrologist, and a transplant

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Simic, Dusica, Milan Djukic, Ivana Budic, Irina Milojevic, and Veljko Strajina. "Anaesthesia for noncardiac surgery in children with congenital heart disease." Srpski arhiv za celokupno lekarstvo 139, no. 1-2 (2011): 107–15. http://dx.doi.org/10.2298/sarh1102107s.

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Children with Congenital Heart Disease (CHD) presenting for non-cardiac surgery have various physiological and functional abnormalities and thus pose great challenges to the anaesthesiologist. The principles of anaesthesia are to minimize pathophysiological changes which may upset the complex interaction between systemic and pulmonary vascular resistance. Knowledge of the specific cardiac anatomy, familiarity with the modifications of the cardiorespiratory physiology, the awareness of the potential risks of complications for each individual case are mandatory for the choice of the anaesthesia

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Burnside, Jeffery L., Todd M. Ratliff, Ashley B. Hodge, Daniel Gomez, Mark Galantowicz, and Aymen Naguib. "Bloodless Repair for a 3.6 Kilogram Transposition of the Great Arteries with Jehovah’s Witness Faith." Journal of ExtraCorporeal Technology 49, no. 4 (2017): 307–11. http://dx.doi.org/10.1051/ject/201749307.

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Achieving pediatric cardiac surgery using cardiopulmonary bypass (CPB) without allogeneic blood transfusion is challenging. There are many clinical and economic factors that point to the importance of avoiding blood transfusions. In some instances, honoring patients or parents beliefs may be the reason for avoiding blood transfusions. For example, patients or parents of the Jehovah’s Witness faith refuse blood transfusion based on their religious beliefs. Over the last decade, our institution has seen a steady increase in our pediatric Jehovah’s Witness patient population. Caring for these pat

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Mirić, Ljubiša, Tijana Smiljković, Vladan Perić, Slađana Mirić, and Tjaša Ivošević. "Ebstejn's anomaly in patients perioperative period during a non-cardiac surgery operation." Praxis medica 49, no. 3-4 (2020): 55–59. http://dx.doi.org/10.5937/pramed2004055m.

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Introduction: Ebstein anomaly, a congenital heart defect characterized by a morphological and functional abnormality of the tricuspid valvula while moving the mouth of the tricuspid valvula towards the apex of the right chamber. Case report: A patient aged 39 years on the Department of Surgery was admitted under the image of an acute abdomen and the need for emergency surgical treatment. Routine preoperative preparation, laboratory treatment, examination of internist and examination of anesthesiologist on the part of the part was carried out. He has a history of occasional breathing problems d

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Kazarin, Nikita, and Malkan Amkhadova. "PREOPERATIVE DIAGNOSIS IN PATIENTS WITH DISEASES OF THE CARDIOVASCULAR SYSTEM BEFORE DENTAL IMPLANTATION SURGERY (LITERATURE REVIEW)." Actual problems in dentistry 19, no. 4 (2024): 5–11. http://dx.doi.org/10.18481/2077-7566-2023-19-4-5-11.

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The subject of the study. Dental implantation for patients with cardiovascular diseases is an urgent and important area, but requires special attention from doctors and patients. Cardiovascular diseases can be a risk factor for implant rejection due to the fact that they often have a direct effect on blood flow to tissues. A review of literature sources in the period from 2017 to 2023 showed that there is no common point of view in the scientific community regarding the implementation of implantation in patients with hypertension and coronary heart disease.  Objectives. To study the spec

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Kyosev, Vasil, Plamen Ivanov, Ventsislav Mutafchyiski, et al. "Minimally invasive transabdominal preperitoneal repair of incisional lumbar hernia." Journal of Endourology and Minimally Invasive Surgery 10, no. 1 (2022): 47–52. http://dx.doi.org/10.57045/jemis/1010722.pp47-52.

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Introduction: A lumbar hernia is a rare type of abdominal wall defect by anatomic location. It can be primary in origin over the lumbar triangles that can be categorized into superior (Grynfeltt) and inferior (Petit), or secondary as a result of trauma or surgery. Lumbar abdominal wall hernia in which clinical presentations may vary from an asymptomatic bulge in the lumbar area to a symptomatic lumbar mass with back pain. Anatomical location makes challenging diagnosis and repair. Individual approach for every patient is a key for successful surgical treatment. In this paper, we present a mini

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Gogayeva, Olena K. "Algorithms of Perioperative Management of High-Risk Cardiac Surgery Patients with Coronary Artery Disease and Polymorbidity." Ukrainian Journal of Cardiovascular Surgery 31, no. 1 (2023): 10–18. http://dx.doi.org/10.30702/ujcvs/23.31(01)/g005-1018.

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The aim. To analyze the effectiveness of the developed algorithms for the perioperative management of high-risk cardiac surgery patients with coronary artery disease (CAD) and polymorbidity. Materials and methods. We analyzed perioperative management of 354 high-risk cardiac surgery patients with CAD with EuroSCORE II predicted mortality >5%, among which 194 (54.8%) underwent isolated coronary artery bypass grafting, and 160 (45.2%) had surgical myocardial revascularization with accompanying valvular pathology correction or left ventricular postinfarction aneurysm resection. All the p

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Bradic, Zeljko, Branislava Ivanovic, Dejan Markovic, Dusica Simic, Radmilo Jankovic, and Nevena Kalezic. "Preoperative preparation of patients with cardiomyopathies in non-cardiac surgery." Acta chirurgica Iugoslavica 58, no. 2 (2011): 39–43. http://dx.doi.org/10.2298/aci1102039b.

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Cardiomyopathies are myocardial diseases in which there is structural and functional disorder of the heart muscle, in the absence of coronary artery disease, hypertension, valvular disease and congenital heart disease. Cardiomyopathies are grouped into specific morphological and functional phenotypes: dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and unclassified cardiomyopathies. Patients with dilated and hypertrophic cardiomypathy are prone to the development of congestive heart failure in the perioperative pe

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Mukhamadeev, M. F., E. S. Dumanyan, R. A. Yakubov, B. Z. Zagidullin, and G. M. Khayrutdinova. "Transformation of Cardiac Intensive Care Wards Into Cardiac Resuscitation Department. The Five-year Evolution." Russian Sklifosovsky Journal "Emergency Medical Care" 12, no. 1 (2023): 145–51. http://dx.doi.org/10.23934/2223-9022-2023-12-1-145-151.

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The article highlights the key elements and results of the restructuring of emergency care for patients with acute myocardial infarction, the core of which is the teamwork of surgeons, anesthesiologist-intensivists and cardiologists of the department. The restructuring included a change in ideology, personnel changes, updating and expanding the range of equipment, development of inner protocols and their implementation. It took two years to transform the intensive care unit for patients with acute myocardial infarction into the cardiac intensive care unit, where patients with acute cardiac pat

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Ladouceur, Magalie, Lena Valacco, Zied Ltaief, Tobias Rutz, Sébastien Hascoet, and Judith Bouchardy. "Perioperative Risk in Adults with Congenital Heart Disease Undergoing Non-Cardiac Surgery: Challenges and Tailored Strategies." Journal of Clinical Medicine 14, no. 10 (2025): 3340. https://doi.org/10.3390/jcm14103340.

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Advances in surgical and medical management of congenital heart disease have improved survival rates, leading to a growing population of adult congenital heart disease (ACHD) patients requiring specialized perioperative care. Studies indicate that ACHD patients undergoing non-cardiac surgery (NC surgery) have increased mortality and morbidity risks compared to the general population, with complication rates particularly high in those with complex defects, such as Fontan circulation, Eisenmenger syndrome, or cyanotic congenital heart disease. Key perioperative concerns include hemodynamic insta

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Zyuzin, V. S. "Preoperative bleeding risk assessment in cardiac surgery patients." Surgical practice (Russia), no. 2 (July 16, 2024): 80–96. http://dx.doi.org/10.5922/2223-2427-2024-9-2-6.

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Aim: To investigate the role of bleeding risk scores, personal and family medical history, and previous bleeding incidents in assessing the impact on the risk of all possible complications, including mortality, in adult patients following cardiac surgery.Methods. The search for publications was conducted using the PubMed, Transfusion Evidence Library, and eLibrary.ru databases, covering the period from 2019 to 2023. Search terms included: ‘bleeding risk assessment scales in adult cardiac surgery’, ‘preoperative anemia in adult cardiac surgery’, and ‘transfusion of red blood cell-containing com

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Nguyễn, Ngọc Thạch, Quang Bình Nguyễn, Hải Trung Lê, Duy Toàn Nguyễn, and Thanh Tuấn Trần. "General anesthesia for giant tumor resection and facial reconstruction in a patient with atrial fibrillation, hypertension, heart valve diseases (Case report)." Tạp chí Y học Thảm hoạ và Bỏng, no. 6 (January 26, 2022): 41–47. http://dx.doi.org/10.54804/yhthvb.6.2021.92.

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General anesthesia for giant tumor resection and facial reconstruction in the elderly patients with atrial fibrillation, hypertension, and comorbidity valvular heart disease presents a major challenge for both anesthesiologists and surgeons in terms of the prevention and management of complications that may occur before, during, and after surgery.A 74-year-old cachexia female suffered from a giant facial tumor compressing on the right eye, right nose, narrowing the left nasal cavity, growing into the palpate. She had atrial fibrillation, hypertension, comorbidity valvular heart disease. Before

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Dhanure, Vinit, Nikhil Bhalerao, and Amreesh Paul. "Anesthesia in Long QT syndrome: A review of pathophysiology, risk factors, and management strategies." Multidisciplinary Reviews 8, no. 10 (2025): 2025277. https://doi.org/10.31893/multirev.2025277.

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Long QT syndrome (LQTS) poses significant challenges in anesthetic management due to its potential to provoke life-threatening arrhythmias such as Torsades de Pointes, which can lead to sudden cardiac death if not properly managed. This review examines the pathophysiology of LQTS, its classification into congenital and acquired forms, and the associated anesthetic risks, while providing evidence-based strategies for its safe and effective management. Congenital LQTS is subdivided into LQT1, LQT2, and LQT3, each associated with distinct genetic mutations, ion channel dysfunctions, and specific

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Corigliano, K., M. Grandinetti, G. Mazzenga, et al. "A MULTIDISCIPLINARY APPROACH TO RARE AND GENETIC AORTIC DISEASE." Journal of Cardiovascular Medicine 25, Supplement 1 (2024): e7. https://doi.org/10.2459/01.jcm.0001096196.55310.9a.

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Background and Aim: Considering the increasing number of genetical diagnosis regarding connective tissue syndromes (Marfan, Ehlers-Danlos, Loeys-Dietz), there is an increasing attention about young patients developing acute aortic syndromes, which can be catastrophic at times. Care of these patients represents a major challenge, due to the variability in timing and severity of the clinical presentation, also determined by the underlying genetic substrate. Methods: In this retrospective study we consider two groups of patients with known connective tissue disease who underwent aortic surgery an

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Gambardella, R., F. Ferraro, A. Olimpieri, et al. "P147 THE WINNING FORMULA IN COMPLEX ADULT CONGENITAL REDO INTERVENTIONS: MULTIDIMENSIONAL PERSPECTIVE IN A HYBRID SETTING." European Heart Journal Supplements 25, Supplement_D (2023): D98. http://dx.doi.org/10.1093/eurheartjsupp/suad111.229.

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Abstract Introduction Transposition of the great artery is one of the most common congenital heart anomalies [1]. One of the surgical techniques to correct this anomaly is the Rastelli procedure [2]. After surgical correction, right and left ventricular outflow obstruction are the most common late complications [3]. In grown–up congenital disease (GUCH) late surgery is a high risk procedure and, repeated sternotomy may be associated with adverse injuries to mediastinal structures.The aim of this work is to demonstrate how a preoperative planning may be helpful in identifying patients at risk o

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Çiçek, Vedat, Tufan Cinar, Mert Ilker Hayiroglu, et al. "Preoperative cardiac risk factors associated with in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery: a single-centre study." Postgraduate Medical Journal, September 10, 2020, postgradmedj—2020–138679. http://dx.doi.org/10.1136/postgradmedj-2020-138679.

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IntroductionIn the present study, our aim was to ascertain the preoperative cardiac risk factors related to the in-hospital mortality in the elderly patients (aged over 65 years) who required preoperative cardiology consultation for hip fracture surgery.Material and MethodsThe present study was a retrospective, single-centre study, which enrolled consecutive elderly patients without heart failure scheduled for hip fracture surgery in our institution. In all patients, an anesthesiologist performed a detailed preoperative evaluation and decided the need for the cardiac consultation. Patients und

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Tommasino, Concezione. "Cardiovascular risk assessment in the senior population undergoing anesthesia for non-cardiac surgery." Monaldi Archives for Chest Disease 87, no. 2 (2017). http://dx.doi.org/10.4081/monaldi.2017.853.

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<p>Older patients are underrepresented in major cardiovascular trials, and only relatively healthy elderly patients, with few comorbidities or functional impairments, have been enrolled. As a result, current guidelines are unable to provide evidence-based recommendations for anesthesia treatment of patients aged ≥75 years, undergoing non-cardiac surgical procedures. Effective strategies, aimed at reducing the risk of perioperative cardiac complications, should involve cardiac evaluation using mostly medical history. A key component is the evaluation of active or unstable cardiac conditio

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Castiglioni, B., A. Bacuzzi, S. Biasoli, et al. "PREOPERATIVE CARDIAC EVALUATION: ENHANCING LOCAL HUMAN RESOURCE EMPLOYMENT THROUGHT A SCREENING TOOL." European Heart Journal Supplements 27, Supplement_5 (2025). https://doi.org/10.1093/eurheartjsupp/suaf076.397.

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Abstract Introduction The implementation of structured pathways for outpatient preoperative assessment is a critical advancement in perioperative medicine, aiming to improve patient safety, optimize resource allocation, and enhance clinical outcomes. The paper describes development and deployment of a cardiac preoperative assessment pathway in non cardiac surgery at Varese Hospital (Ospedale di Circolo Varese ASST Settelaghi). Materials and Methods The pathway integrates validated scoring systems such as the American Society of Anesthesiologists (ASA) Physical Status Classification, Revised Ca

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Saccocci, M., M. Diego, E. Villa, et al. "P85 THE SUPERPOWERS OF A REAL HEART TEAM: TAVR AND PERIOPERATIVE MANAGEMENT OF A PATIENT WITH COREA DISORDER." European Heart Journal Supplements 24, Supplement_C (2022). http://dx.doi.org/10.1093/eurheartj/suac012.082.

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Abstract Aortic stenosis is the most common valve disease in over75 years old patients.Managing the preoperative assessment and the perioperative course could be problematic in frailty patients.Having a real and solid multidisciplinary heart team(MDHT)is essential.This is how we succeeded in optimizing the treatment of 82–year–old patient affected by Huntington‘s disease(HD) and severe symptomatic aortic valve stenosis.HD is an autosomal–dominant progressive neurodegenerative pathology due to an expanded CAG repeat leading to a mutant protein(huntingtin) and it‘s usually characterized by chore

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Liana, Magamedovna Khaladova, Vladimirovna Khaymina Nicole, Vladimirovna Pasynkova Viktoria, et al. "The influence of cardiovascular diseases on the outcomes of surgical treatment in gynecology." Revista Latinoamericana de Hipertension (Latin American Journal of Hypertension) 20, no. 5 (2025). https://doi.org/10.5281/zenodo.15535591.

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Cardiovascular diseases (CVD) are one of the most significant factors influencing the outcomes of surgical treatment of gynecological pathologies. Given the high prevalence of CVD among older women and patients with chronic diseases, their impact on the course of the surgical and postoperative periods deserves special attention. The authors analyze the mechanisms of interrelation of cardiovascular disorders and surgical interventions in gynecology. The main cardiological conditions, such as arterial hypertension, coronary artery disease (CAD), heart failure, cardiac arrhythmias and thromboembo

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Ishikawa, Takuma, Shinji Itoh, Takeo Toshima, et al. "Robot-assisted laparoscopic hepatectomy for hepatocellular carcinoma with Fontan-associated liver disease: a world-first case report." Surgical Case Reports 10, no. 1 (2024). http://dx.doi.org/10.1186/s40792-024-02014-5.

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Abstract Background Fontan-associated liver disease (FALD) encompasses hepatic complications following the Fontan procedure, ranging from fibrosis to hepatocellular carcinoma (HCC). Despite advancements in surgical techniques and perioperative care, robot-assisted laparoscopic hepatectomy (RALH) for HCC in patients with FALD has not been previously reported owing to concerns about the Fontan circulation. Case presentation We present the first case of RALH for recurrent HCC in a 45-year-old man after the Fontan procedure. The preoperative evaluation confirmed good cardiac function. The procedur

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Boccanelli, Alessandro, and Pompilio Faggiano. "Preoperative risk evaluation in patients over 75 years candidates to non-cardiac and cardiac surgery." Monaldi Archives for Chest Disease 87, no. 2 (2017). http://dx.doi.org/10.4081/monaldi.2017.845.

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<p>In the 24<sup>th</sup> and 25<sup>th</sup>of June 2016, 80 national experts were invited to Rome from The Italian Society of Geriatric Cardiology and the Italian Association of Cardiovascular Prevention and Rehabilitation to revise the current knowledge on the perioperative risk in the elderly. Cardiologists, geriatricians, heart and general surgeons and anesthesiologists discussed the topic with the objective of reaching a consensus and to launch observational research and registries in the field of perioperative risk evaluation in the elderly. The introductio

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Mureddu, Gian Francesco, Pompilio Faggiano, and Francesco Fattirolli. "Preoperative evaluation before non cardiac surgery in subjects older than 65 years." Monaldi Archives for Chest Disease 82, no. 1 (2015). http://dx.doi.org/10.4081/monaldi.2014.39.

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Non cardiac surgery is becoming increasingly common in elderly patients; they are usually affected by overt cardiac disease or show multiple risk factors, responsible for a higher incidence of perioperative fatal or nonfatal cardiac events. Of interest, acute myocardial infarction occurring in the perioperative period shows a high mortality rate in people over 65 years old. The cardiovascular risk stratification and perioperative management of subjects undergoing noncardiac surgery have been recently updated in the 2014 European Society of Cardiology Guidelines. However, several critical point

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Richter, Ellen W., Islam M. Shehata, Hamdy M. Elsayed-Awad, Matthew A. Klopman, and Sujatha P. Bhandary. "Mitral Regurgitation in Patients Undergoing Noncardiac Surgery." Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2021, 108925322110428. http://dx.doi.org/10.1177/10892532211042827.

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Mitral regurgitation (MR) is one of the most frequently encountered types of valvular heart disease in the United States. Patients with significant MR (moderate-to-severe or severe) undergoing noncardiac surgery have an increased risk of perioperative cardiovascular complications. MR can arise from a diverse array of causes that fall into 2 broad categories: primary (diseases intrinsic to the valvular apparatus) and secondary (diseases that disrupt normal valve function via effects on the left ventricle or mitral annulus). This article highlights key guideline updates from the American College

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Kaprin, Andrey, Oleg Pikin, Andrey Ryabov, Oleg Aleksandrov, Denis Larionov, and Airat Garifullin. "Surgical intervention for lung cancer in patients aged 75 and above: potential associations with increased mortality rates—a single-center observational study." Journal of Cardiothoracic Surgery 19, no. 1 (2024). http://dx.doi.org/10.1186/s13019-024-02922-5.

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Abstract Background Lung cancer, which is diagnosed two to three times more frequently in patients over the age of 70, is a leading cause of cancer-specific mortality. Given the elevated risk of morbidity and mortality, surgical intervention may not always be the most appropriate primary treatment option. This study aims to evaluate specific risk factors associated with postoperative morbidity and mortality in elderly patients and to optimize patient selection therefore improving surgical outcomes. Patients and methods The study encompassed a cohort of 73 patients aged 75 and above who underwe

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Novitskaya, Maria, Mark Sonbol, Sabih Jafri, Joseph Monye, and Emily Japp. "FRI207 Challenges Of Pheochromocytoma Management In A Heart Failure Patient." Journal of the Endocrine Society 7, Supplement_1 (2023). http://dx.doi.org/10.1210/jendso/bvad114.202.

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Abstract Disclosure: M. Novitskaya: None. M. Sonbol: None. S. Jafri: None. J. Monye: None. E. Japp: None. Introduction: Successful management of pheochromocytoma in patients with heart failure requires a careful balance between blood pressure control and appropriate perioperative volume resuscitation. Clinical Case: A 38-year-old male with heart failure with reduced ejection fraction (EF 15-20%), HTN, and polysubstance use disorder presented with dyspnea and subsequent in-house PEA arrest. Whole body CT showed an incidental 7.3 cm left adrenal mass. Laboratory work-up was notable for elevated

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Harraz, Mohamed M., Ahmed H. Abouissa, Hala A. Saleh, et al. "MDCT angiographic findings of various congenital pulmonary artery anomalies in pediatric patients." Egyptian Journal of Radiology and Nuclear Medicine 50, no. 1 (2019). http://dx.doi.org/10.1186/s43055-019-0089-5.

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Abstract Background Congenital pulmonary artery anomalies are variable and need proper diagnosis and treatment. CT angiography with multiplanar reconstruction has the main role in the assessment of these anomalies and this non-invasive method should be the method of choice for preoperative planning and postoperative follow up. The aim of the study is to assess the value of MDCT in the detection of pulmonary arteries anomalies in the pediatric population with complex congenital heart disease in conjunction with echocardiography as an alternative to conventional angiography and to determine the

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Pozzi, Matteo, Silvia Mariani, Margherita Scanziani, et al. "The frail patient undergoing cardiac surgery: lessons learned and future perspectives." Frontiers in Cardiovascular Medicine 10 (December 6, 2023). http://dx.doi.org/10.3389/fcvm.2023.1295108.

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Frailty is a geriatric condition characterized by the reduction of the individual's homeostatic reserves. It determines an increased vulnerability to endogenous and exogenous stressors and can lead to poor outcomes. It is an emerging concept in perioperative medicine, since an increasing number of patients undergoing surgical interventions are older and the traditional models of care seem to be inadequate to satisfy these patients' emerging clinical needs. Nowadays, the progressive technical and clinical improvements allow to offer cardiac operations to an older, sicker and frail population. F

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