Geriatric Cardiology Research Articles

Reflections on the Practice of Geriatric Cardiology After a Mid-Career Geriatrics Fellowship

Reflections on the Practice of Geriatric Cardiology After a Mid-Career Geriatrics Fellowship

Geriatric Cardiology: Moving Beyond Learning by Osmosis

Geriatric Cardiology: Moving Beyond Learning by Osmosis

Is it time for Heart-Brain clinics? A clinical survey and proposition to improve current care for cognitive problems in heart failure.

Cognitive impairment is highly prevalent among patients with heart failure (HF). International guidelines on the management of HF recommend screening for cognitive impairment and tailored care for patients with cognitive impairment. However, practical guidance is lacking. In this study, we explore cardiologists'perspective on screening and care for cognitive impairment in patients with HF. We give an example of a multidisciplinary Heart-Brain care pathway that facilitates screening for cognitive impairment in patients with HF. We distributed an online survey to cardiologists from the Dutch working groups on Geriatric Cardiology and Heart Failure. It covered questions about current clinical practice, impact of cognitive impairment on clinical decision-making, and their knowledge and skills to recognize cognitive impairment. Thirty-six out of 55 invited cardiologists responded. Only 3% performed structured cognitive screening, while 83% stated that not enough attention is paid to cognitive impairment. More than half of the cardiologists desired more training in recognizing cognitive impairment and three-quarters indicated that knowing about cognitive impairment would change their treatment plan. Eighty percent agreed that systematic cognitive screening would benefit their patients and 74% wished to implement a Heart-Brain clinic. Time and expertise were addressed as the major barriers to screening for cognitive impairment. Although cardiologists are aware of the clinical relevance of screening for cognitive impairment in cardiology patients, such clinical conduct is not yet commonly practiced due to lack of time and expertise. The Heart-Brain care pathway could facilitate this screening, thus improving personalized care in cardiology.

Observation of Clinical Treatment Efficacy in Severe Heart Failure of Geriatric Cardiology

Observation of Clinical Treatment Efficacy in Severe Heart Failure of Geriatric Cardiology

Geriatric cardiology: general provisions

The increase in life expectancy, thanks not least to the success of disease prevention and treatment, has led to a global restructuring of the population structure with a dramatic increase of the elderly and long-livers. Characteristics for elderly patients are the spectrum of age-associated types of pathology, disease-nonspecific symptoms and syndromes, polypharmacy, and functional in capacity which require a fundamentally different approach from the «disease-centered» approach in modern medicine. The review examines the history of geriatric cardiology and its demographic factors, the tasks of geriatric cardiology at the current stage of the development of clinical medicine, focuses on a number of specific geriatric conditions such as multimorbidity, polypharmacy, geriatric syndromes, and the limited representation of geriatric aspects of cardiovascular diseases in the recommendations of the European Society of Cardiology. It is emphasized that the organic incorporation of principles and methods of comprehensive geriatric assessment into the traditional cardiological diagnostic and treatment process using methods of geriatric screening, geriatric diagnosis, creation of individual treatment and recovery programs will allow to improve the quality of life, functional status, to prevent traumatic events and acute conditions in of elderly patients, to reduce the burden on the medical and social security system.

How to Improve Clinical Outcomes and Reduce Cardiovascular Risk in Older People with Cardiovascular Disease: Bridging Evidence Gaps.

The geriatric population is greatly impacted by cardiovascular disease. Thus, it becomes essential to 'geriatricise' the cardiologist through the dissemination of geriatric cardiology. In the early days of geriatric cardiology, it was discussed whether it was simply cardiology 'well done'. Today, 40 years later, it seems clear that this is indeed the case. Patients with cardiovascular disease usually have several chronic conditions. Clinical practice guidelines often address a single condition and do not provide sufficient guidance for patients with multimorbidity. There are several evidence gaps regarding these patients. Physicians and members ofthe care team need a multidimensional understanding ofthe patient to better promote the optimisation of care. It is important to understand that ageing is inevitable, heterogeneous and increases vulnerability. Caregivers must know how to assess elderly patients in a multidomain practical way and how to recognise the factors that may have implications on treatment.

Geriatric cardiology - an imperative of our time

Cardiovascular disease is the leading cause of morbidity and mortality, especially in older adults. The older are characterized by a combination of CVD with other non-infection chronic diseases, changes in cognitive and functional status, social and economic circumstances. To date, there are no formalized guidelines for managing patients in response to all issues, since historically clinical recommendations are «disease-centric», while older patients with CVD require an inclusive and integrative patient-centric approach to insure comprehensive health care. Integration of the basic principles of cardiovascular disease management and the principles of geriatrics is becoming increasingly necessary to provide high quality care for older patients.

Cardiac Structural and Functional Features in Patients With Type 2 Diabetes Mellitus and Heart Failure With Preserved Ejection Fraction:A Study Based on Propensity Score Matching

Objective To investigate the cardiac structural and functional characteristics in the patients with heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM),and predict the factors influencing the characteristics. Methods A total of 783 HFpEF patients diagnosed in the Department of Geriatric Cardiology,the First Hospital of Lanzhou University from April 2009 to December 2020 were enrolled in this study.Echocardiography and tissue Doppler technique were employed to evaluate cardiac structure and function.According to the occurrence of T2DM,the patients were assigned into a HFpEF+T2DM group (n=332) and a HFpEF group (n=451).Propensity score matching (PSM)(in a 1∶1 ratio) was adopted to minimize confounding effect.According to urinary albumin excretion rate (UAER),the HFpEF+T2DM group was further divided into three subgroups with UAER<20 μg/min,of 20-200 μg/min,and>200 μg/min,respectively.The comorbidities,symptoms and signs,and cardiac structure and function were compared among the groups to clarify the features of diabetes related HFpEF.Multivariate linear regression was conducted to probe the relationship of systolic blood pressure,blood glucose,glycosylated hemoglobin,and UARE with cardiac structural and functional impairment. Results The HFpEF+T2DM group had higher prevalence of hypertension (P=0.001) and coronary heart disease (P=0.036),younger age (P=0.020),and larger body mass index (P=0.005) than the HFpEF group,with the median diabetic course of 10 (3,17) years.After PSM,the prevalence of hypertension and coronary heart disease,body mass index,and age had no significant differences between the two groups(all P>0.05).In addition,the HFpEF+T2DM group had higher interventricular septal thickness (P=0.015),left ventricular posterior wall thickness (P=0.040),and left ventricular mass (P=0.012) and lower early diastole velocity of mitral annular septum (P=0.030) and lateral wall (P=0.011) than the HFpEF group.Compared with the HFpEF group,the HFpEF+T2DM group showed increased ratio of early diastolic mitral filling velocity to early diastolic mitral annular velocity (E/e') (P=0.036).Glycosylated hemoglobin was correlated with left ventricular mass (P=0.011),and the natural logarithm of UAER with interventricular septal thickness (P=0.004),left ventricular posterior wall thickness (P=0.006),left ventricular mass (P<0.001),and E/e' ratio (P=0.049). Conclusion The patients with both T2DM and HFpEF have thicker left ventricular wall,larger left ventricular mass,more advanced left ventricular remodeling,severer impaired left ventricular diastolic function,and higher left ventricular filling pressure than the HFpEF patients without T2DM.Elevated blood glucose and diabetic microvascular diseases might play a role in the development of the detrimental structural and functional changes of the heart.

Screening for obstructive sleep apnea before coronary angiography.

The prevalence of obstructive sleep apnea (OSA) in patients with suspected coronary heart disease (CHD) is yet to be clarified. This study aimed to investigate the prevalence of OSA before coronary angiography (CAG). We retrospectively evaluated patients with suspected CHD admitted to the Department of Geriatric Cardiology of our hospital between July 2019 and July 2021. OSA was screened using the level III home sleep apnea test before CAG. The prevalence of OSA was then compared between the CHD and non-CHD groups. CHD severity was determined using the Gensini score of CAG results, and OSA severity was graded using the apnea-hypopnea index (AHI). Among the 327 patients, 211 had CHD. In total, 264 patients were diagnosed with OSA (80.7%) (184 patients, CHD group [87.2%]; 80 patients, non-CHD group [69.0%]). The CHD group had a significantly higher prevalence of OSA (P < 0.01) and higher AHI (CHD group 18.76 ± 14.94, non-CHD group 11.56 ± 10.67, P < 0.01). The Gensini score was positively correlated with OSA severity in patients with CHD, and AHI ≥ 20 was a risk factor for CHD (odds ratio: 1.961, 95% confidence interval: 1.065-3.608, P < 0.05). OSA screening before CAG revealed a higher prevalence in CHD patients than in non-CHD patients. The degree of coronary artery obstruction is positively correlated with AHI, and AHI ≥ 20 is a risk factor for CHD. Therefore, attention should be paid to OSA screening and management before CAG in patients with suspected CHD.

Digital health in older adults for the prevention and management of cardiovascular diseases and frailty. A clinical consensus statement from the ESC Council for Cardiology Practice/Taskforce on Geriatric Cardiology, the ESC Digital Health Committee and the ESC Working Group on e-Cardiology.

Digital health technology is receiving increasing attention in cardiology. The rise of accessibility of digital health tools including wearable technologies and smart phone applications used in medical practice has created a new era in healthcare. The coronavirus pandemic has provided a new impetus for changes in delivering medical assistance across the world. This Consensus document discusses the potential implementation of digital health technology in older adults, suggesting a practical approach to general cardiologists working in an ambulatory outpatient clinic, highlighting the potential benefit and challenges of digital health in older patients with, or at risk of, cardiovascular disease. Advancing age may lead to a progressive loss of independence, to frailty, and to increasing degrees of disability. In geriatric cardiology, digital health technology may serve as an additional tool both in cardiovascular prevention and treatment that may help by (i) supporting self-caring patients with cardiovascular disease to maintain their independence and improve the management of their cardiovascular disease and (ii) improving the prevention, detection, and management of frailty and supporting collaboration with caregivers. Digital health technology has the potential to be useful for every field of cardiology, but notably in an office-based setting with frequent contact with ambulatory older adults who may be pre-frail or frail but who are still able to live at home. Cardiologists and other healthcare professionals should increase their digital health skills and learn how best to apply and integrate new technologies into daily practice and how to engage older people and their caregivers in a tailored programme of care.

Geriatric cardiology in daily clinical practice.

Geriatric cardiology in daily clinical practice.

All-Cause Mortality as an End Point for Heart Failure With Preserved Ejection Fraction: Underperformance or Overambitious?

All-Cause Mortality as an End Point for Heart Failure With Preserved Ejection Fraction: Underperformance or Overambitious?

Selección de lo mejor del año 2021 en cardiología geriátrica

In this text we review some of the main studies related to the diagnosis and treatment of the most prevalent cardiovascular diseases in older patients published during the last year, also highlighting the importance of adequate prevention, both primary and secondary. Similarly, prevalent entities such as ischemic heart disease, atrial fibrillation or heart failure, among others, deserve special attention, as well as the role of cardiac rehabilitation in older patients, given its benefits and prognostic impact regarding it addresses to a large extent some of the common geriatric syndromes in this population. Finally, we review some important aspects in the current COVID-19 pandemic and some of the works led by the Geriatric Cardiology Section of the Spanish Society of Cardiology.

Geriatric medicine: achievements and prospects

The article is a lecture on the history of development and the current state of geriatric medicine. The purpose of the lecture is to consider the stages of the formation of geriatrics as a scientific and clinical discipline and to substantiate its significance. The lecture defines concepts such as holistic approach, complex geriatric assessment, geriatric syndrome. The role of the founders of international and domestic geriatrics, such as M. Warren, B. Isaac, D. Sheldon, I.I. Mechnikov, V.N. Anisimov, E.S. Pushkova, is described. Various directions of geriatric medicine are considered and the necessity of their study is justified. The results of scientific research in geriatrics are analyzed. The basic principles of the ortho-geriatric approach, which becomes crucial for the successful treatment of elderly patients with fractures, as well as the features of geriatric rehabilitation, geriatric cardiology, are described. In conclusion, the author offers several models for the development of geriatric medicine.

Abstract 11638: Cardiologists’ Knowledge and Attitude Toward Geriatric Cardiology Training

Introduction: By 2030, it is projected that 20% of the population will be 65 or older. Older adults aged 85 and over (the oldest old) are the fastest growing segment of the US population and globally. As the population ages, cardiovascular disease is becoming a major public health challenge. Providing optimal care to older adults with CVD is challenging due to their complexity, competing vulnerabilities and a lack of evidence-based knowledge to bridge the existing gap between guidelines and real-world clinical practice. Hypothesis: Exposure to geriatric education during training will associate with attitudes toward treatment of older adult patients. Objective: Evaluate current cardiologists’ knowledge and attitude toward geriatric care. Methods: IRB-approved, quantitative cross-sectional study using an online survey distributed to all cardiologists and cardiology fellows within a large academic medical system. Result: Of the 98 physicians invited, 26 responded (26.5% response rate) of which 19.2% were female; 45% cardiology fellows, 5% early career (&lt; 5 years) and 50% experienced cardiologists (&gt;10 years). Of those surveyed, 77% reported more than half of their patients were over age 65. While 87% believed it was very important for cardiologists to have knowledge about geriatric syndromes, 70% reported little to moderate levels of knowledge about their impact on CV care. Only 20% reported a deep fund of knowledge. Most knowledge was gained through experience rather than formal education. None of the participants were aware of the “Essentials of Cardiovascular Care in Older Adults (ECCOA)” curriculum within the Geriatric Cardiology section of ACC. Two thirds were concerned about potential overtreatment for older adults, whereas 41% were concerned for potential undertreatment. Conclusion: Academic-affiliated cardiologists surveyed reported unmet educational needs regarding care of older adults. Efforts to equip cardiologists with the requisite up- to -date knowledge of geriatric cardiology are needed to formulate a balanced and holistic therapeutic plan of care for our most vulnerable patients.

Atrial fibrillation and geriatric syndromes: an association beyond traditional risk factors

Abstract Objectives Atrial fibrillation (AF) is particularly frequent in nonagenarian patients, in whom geriatric syndromes (GS) are also often present and may interfere with treatment decision-making and impact prognosis. Previous work has identified an association between AF and GS in older adults; however, available data is limited for nonagenarian patients and other possibly associated factors. Therefore, this study aims to describe the association between AF and GS in nonagenarian patients. Methods This is a cross-sectional study of 205 nonagenarian patients followed in a third-level hospital's Geriatric Cardiology Clinic. Sociodemographic factors, comorbidities, and GS were investigated. To determine the association between AF and GS, multivariate logistic regression analyses were carried out, taking into account other correlations. Results The mean age of participants was 92.56 (SD 2.39) years; 124 (60.5%) were women. AF was present in 30.7% of participants. Most common GS were sarcopenia (77.6%), risk of malnutrition or malnutrition (69.8%), frailty (52.2%), depressive symptoms (45.9%), cognitive impairment (27.3%), and severe disability for activities of daily living (25.4%). In the multivariate logistic regression analysis, AF was independently associated with frailty (OR 2.57; CI 95% 1.32–5.01; p=0.006), malnutrition (OR 1.95; CI 95% 1.3–8, p=0.045), moderate to severe cognitive impairment (OR 2.15; CI 95% 1.11–4.14; p=0.023), and depressive symptoms (OR 5.84; CI 95% 1.16–4.12, p=0.016). Conclusions AF is independently associated with frailty, malnutrition, depressive symptoms, moderate to severe cognitive impairment and severe functional disability in nonagenarian patients. Funding Acknowledgement Type of funding sources: None.

Home-Based Palliative Care Visits for DT-LVAD Patients

Purpose All DT-LVAD patients must receive a palliative care consultation prior to implant. No guidelines exist for post-LVAD palliative care follow up to help patients cope with increasing illness burden. We describe our institution's experience with our health system's home-based palliative care (HBPalC) program. Methods We performed a chart review of DT-LVAD implants at our institution. The MGB HBPalC Program is staffed by an MD Medical Director, 3 nurse practitioners and a social worker. All HBPalC clinicians are certified in palliative care. Patients referred to the program are seen at home. The NP performs an initial assessment and collaborates with the LVAD team in developing a comprehensive care plan, with special attention to symptom management, documentation of hopes and worries, anticipatory planning and recommendations to mitigate unnecessary hospitalizations. Follow up visits are scheduled based on clinical and psychosocial needs. Results In 2018-20, 4 LVAD patients were referred to the HBPalC Program. They were elderly, met the criteria for frailty, and could no longer travel to clinic. The HBPalC team, working closely with LVAD team, managed 3 patients’ symptoms and transitioned them to hospice when appropriate. These patients died peacefully at home or at a hospice residence and none presented to the ED or were hospitalized while enrolled in the HBPalC Program. The 4th patient presented to the emergency room with somnolence and was hypotensive and tachypneic. The HBPalC provider and VAD coordinator collaborated to support the patient's daughter through the difficult decision to deactivate the LVAD, easing anxiety for the patient and her family, as well as preventing a readmission. Conclusion HBPalC is a valuable resource that can help to minimize symptom burden for patients as well as support patients and their families with the complicated transition to hospice, allowing them to die in the location of their choosing, which is often at home. As the number of older adults receiving DT-LVADs grows, the need for closer collaboration between LVAD programs and HBPalC programs will also continue to grow. At our institution, we are exploring workflows to expand this collaboration and are additionally working to develop a Geriatric Cardiology Clinic to better assess for and manage geriatric syndromes pre-implant with the goal of further improving outcomes for this patient population.

Geriatric Cardiology and its Relationship of Coronary Heart Disease

Geriatric cardiology is a relatively new field aimed at transforming cardiovascular protection to an aging population by incorporating fundamentals of geriatric medicine into the systemic care of older adults with cardiovascular disease. The clinical demonstration of Coronary heart disease in older patients shows the effect of the disease superimposed on the physiological effects of age. At autopsy, 40% of elderly women and 85% of elderly men have blockage of blood vessels and it cause coronary heart disease. Octogenarians incorporate 10% of the US population but 15% of the hospitalizations for myocardial infraction. Coronary arteriography older substances have substandard disease than the younger

Advances in Journal of Geriatric Cardiology over the course of a decade.

Advances in Journal of Geriatric Cardiology over the course of a decade.

Selección de lo mejor del año 2020 en cardiología geriátrica

During last year several papers focusing on elderly patients with cardiovascular disease have been published. In this article, we review some of the most important studies focused on the management of elderly patients with heart disease, also including complex clinical scenarios such as the COVID-19 pandemic. We highlight some aspects of great clinical relevance, given their prognostic impact, such as geriatric syndromes and comorbidity, all of them prevalent in the elderly. We also emphasize on how to improve the care we provide to our patients in different scenarios (emergency, hospitalization, outpatients). Finally, we analyze some of the main studies promoted by the Geriatric Cardiology Section of the Spanish Society of Cardiology.