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Cardiologists are currently unprepared for the impact on cardiovascular (CV) care of the ageing population, according to a whitepaper1 published recently in the Journal of the American College of Cardiology.

Geriatric cardiology has become, de facto, mainstream cardiology, say authors led by Dr Daniel Foreman , Boston VA Healthcare Center, Massachusetts.  Cardiology must embrace a broader paradigm beyond the cardiovascular system in order to ensure the provision of optimal care for older patients, both for clinical outcomes and patient satisfaction, the report claims.

doctor-patient-internalConventional evidence-based standards of CV care fail to integrate the complexities or needs specific to older patients, as they were derived from younger study populations and/or elderly patients who were screened to exclude common morbidities of old age, say its authors.

They propose a new paradigm of CV training and patient management incorporating health problems without a cardiac focus – one which synthesises multisystem aging, comorbidities (including atrial fibrillation), polypharmacy, psychosocial factors, and personal preferences into an individualised approach to care.  This expansion, they claim, will enable cardiologists to “better address the complexities of all patients, including…the large and growing population of older adults who now comprise the largest subgroup of CV patients”.

The report also proposes a broader spectrum of alternate endpoints for treatment besides longevity, including quality of life, functional capacity, reduced hospitalisations and personal independence.  Its authors asserts that although longevity may remain the dominant priority for some older adults, “the prospect of excessive pain, hardship (including perceived burden on loved ones), limitation of independence, and/or recurrent hospitalizations may limit the appeal of life-prolonging therapies”.

The proposed paradigm is to focus on:

  • Emphasis on patient-centered approach to care
  • Screening for coexisting geriatric syndromes and comorbidity (e.g., cognitive function, disability, and frailty in patients ≥75 years of age)
  • Purposeful management of pharmacological regimen
  • Emphasis on the importance of transitions of care


1 Forman DE, Rich MW, Alexander KP, et al. Cardiac Care for Older Adults: Time for a New Paradigm. J Am Coll Cardiol 2011;57:801-10.

Published on: May 6, 2011

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