What Can Geriatrics Teach Cardiology?
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INVITED COMMENTARY
What Can Geriatrics Teach Cardiology? Kumar Dharmarajan 1,2
Published online: 24 September 2016 # Springer Science+Business Media New York 2016
Keywords Geriatrics . Elderly . Cardiology . Cardiovascular . Patient outcomes
Introduction Advances in cardiovascular science and therapeutics have spurred great improvements in the lives of older adults. For example, treatment of hypertension has reduced the incidence of heart failure, acute myocardial infarction, and stroke [1, 2]. Medical therapy for coronary artery disease, atrial fibrillation, and heart failure has extended life and lowered hospitalizations [3–5]. And transcatheter and surgical interventions have reduced mortality and improved quality of life [6, 7]. What additional opportunities exist to improve care for older adults with cardiovascular disease? Certainly, novel therapies for specific cardiovascular conditions including heart failure, vascular disease, and valvular heart disease will continue to be developed and advance outcomes. A key challenge, however, will be to employ these treatments in a way that maximizes benefit while minimizing harm. To do so, treatment will need to be guided by holistic perspectives that prioritize outcomes most important to older patients. Providers will also need to recognize older patients’ multiple sources of vulnerability, many of which are unrelated to cardiovascular disease and unlikely to benefit from cardiovascular interventions. * Kumar Dharmarajan [email protected] 1
Section of Cardiovascular Medicine, Yale School of Medicine, 1 Church Street, Suite 200, New Haven, CT 06510, USA
2
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510, USA
A Role for Geriatrics Fortunately, geriatricians have long espoused this multidimensional approach to caring for older adults and can serve as examples for cardiovascular specialists. Some early contributions from geriatrics to cardiology include routine preprocedural assessment for frailty prior to aortic valve replacement. Frailty is a state of reduced physiologic reserve and increased vulnerability to stress that can be identified by the presence of low grip strength, low energy, slowed waking speed, low physical activity, and unintentional weight loss. The presence of frailty significantly increases post-procedural risk and may limit opportunities for recovery [8, 9]. Geriatric perspectives have also illuminated the frequent coexistence of cardiovascular disease with multiple chronic conditions [10]. Multimorbidity can impact prognosis, complicate management, and change priorities for cardiovascular care [11]. Yet insights from geriatric medicine go well beyond considerations of frailty and multimorbidity and suggest the importance of the following: 1. Focus on universal health outcomes that cross diseasespecific boundaries. While many cardiovascular interventions aim to reduce major adverse cardiovascular events such as hospitalizations and death from cardiovascular causes,
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