A Geriatric Approach to Percutaneous Coronary Interventions in Older Adults, Part II: A JACC: Advances Expert Panel

Area of Science:

• Geriatric Medicine
• Interventional Cardiology
• Cardiovascular Disease

Background:

• Older adults represent a growing population undergoing percutaneous coronary interventions (PCI).
• Traditional risk assessments may not fully capture the complexities of aging, including geriatric syndromes.
• Optimizing patient-centered outcomes in this demographic requires a specialized approach.

Purpose of the Study:

• To present a comprehensive risk assessment approach for PCI in older adults.
• To integrate geriatric principles and syndromes into preprocedural risk evaluation.
• To propose strategies for mitigating geriatric-specific risks and improving shared decision-making.

Main Methods:

• Review of current literature on risk assessment in older adults undergoing PCI.
• Conceptualization of a "geriatric" heart team model.
• Discussion of goals of care and pharmacotherapeutic considerations.

Main Results:

• Highlights the importance of geriatric syndromes in PCI risk stratification.
• Proposes a multidisciplinary "geriatric" heart team including geriatric specialists.
• Identifies key areas for shared decision-making and medication management.

Conclusions:

• A geriatric-focused risk assessment and a "geriatric" heart team can enhance PCI outcomes in older adults.
• Addressing geriatric syndromes, goals of care, and pharmacotherapy is crucial.
• Further research is needed to refine these approaches and fill knowledge gaps.