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The older patient with cardiovascular disease: background and clinical implications of the comprehensive geriatric
Renzo Rozzini1,2, Angelo Bianchetti3, Paolo Alboni4
1Società Italiana di Cardiologia Geriatrica (SICGe), Florence, Italy - renzo.rozzini@poliambulanza.it.
Insights
Comprehensive geriatric assessment (CGA) is vital for older cardiovascular patients. It optimizes treatment by evaluating health status and decision-making capacity for personalized care.
Area of Science:
- Geriatric Medicine
- Cardiology
- Surgical Outcomes
Background:
- Comprehensive geriatric assessment (CGA) principles are expanding into medical subspecialties.
- Application in cardiovascular care, including surgery and transcatheter aortic valve replacement (TAVR), is growing.
- CGA addresses postoperative mortality risk in older adults.
Purpose of the Study:
- To explore the application of CGA in cardiovascular subspecialties.
- To define ideal management strategies for diverse older adult patient profiles (robust, intermediate, disabled, end-stage).
- To highlight CGA's role in individualized treatment and preprocedural optimization.
Main Methods:
- Utilizing CGA principles to categorize older cardiovascular patients.
- Assessing global health status and decision-making capacity.
- Tailoring therapeutic goals based on life expectancy and patient type.
Main Results:
- CGA enables classification of patients into distinct groups for tailored management.
- It facilitates selection of appropriate therapeutic goals aligned with life expectancy.
- CGA optimizes preprocedural conditions and supports individualized treatment plans.
Conclusions:
- CGA is crucial for managing older adults in cardiovascular subspecialties.
- It allows for personalized treatment strategies based on patient frailty and capacity.
- Optimizing preprocedural status through CGA improves outcomes for elderly cardiovascular patients.
Abstract:
Principles and processes of comprehensive geriatric assessment (CGA) are increasingly being applied to subspecialties and subspecialty conditions, including cardiovascular patients (i.e., infective endocarditis; considerations of surgery or transcatheter aortic valve replacement, TAVR, for patients with aortic stenosis; vascular surgery) and postoperative mortality risk. In cardiovascular field CGA has mainly the aim to define ideal management according to the different typology of older adult patients (e.g., robust versus intermediate versus physical and cognitively disabled versus end-stage or dying), allowing physicians to select different therapeutic goals according to life expectancy; Aspect to be valued are by CGA are global health status and patient's decision-making capacity: CGA allows the individualized treatment definition and optimize the preprocedure condition.
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