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Published on: September 26, 2018
Cardiovascular disease epidemiology and management in the elderly and very elderly
Giuseppe Galati1,2, Olga Germanova2, Gianmarco Dacquino3
1Unit of Cardiology, Cardiovascular Department, I.R.C.C.S. Maugeri - Cardiovascular Rehabilitation Scientific, Care and Research Institute, Via Crotto Roncaccio, 16, 21049 Tradate, Varese, Italy.
Insights
Cardiovascular diseases (CVD) impact the elderly differently. Heart failure (HF) is a major concern, necessitating frailty assessments to guide management and prevent harmful interventions.
Area of Science:
- Gerontology
- Cardiology
- Public Health
Background:
- Cardiovascular diseases (CVD) represent a significant health challenge in the aging global population.
- The elderly and very elderly exhibit distinct CVD epidemiology and impact compared to younger demographics.
Purpose of the Study:
- To review the epidemiology and novel management strategies for CVD in older adults.
- To emphasize specific CVDs like heart failure (HF), ischaemic heart disease, atrial fibrillation (AF), stroke, valvular heart diseases, and cardiomyopathies (CMP).
- To define 'elderly' considering functional capacity and various aging concepts (vascular, biological, prospective age) and to explore frailty's role in CVD management.
Main Methods:
- This is a narrative review synthesizing current literature on CVD in the elderly.
- Key objectives include defining aging populations and assessing frailty's influence on treatment decisions.
Main Results:
- Heart failure (HF) is identified as the most impactful CVD on quality and quantity of life in the elderly.
- CVD presents unique challenges and requires tailored management in older individuals.
- Frailty assessment is crucial for optimizing benefit and avoiding harm from interventions.
Conclusions:
- Older adults are a growing population with unique CVD profiles.
- Management strategies must account for individual patient characteristics, including frailty.
- Multidisciplinary frailty evaluation is essential to guide decision-making, particularly avoiding futile aggressive treatments.
Aims:
The aim of this narrative review is to focus on the epidemiology and new advances in the management of cardiovascular diseases (CVDs) in the elderly and very elderly, with particular emphasis on those CVDs that are most relevant and have the greatest impact on morbidity and mortality, such as heart failure (HF), ischaemic heart disease, atrial fibrillation and stroke, valvular heart diseases, and cardiomyopathies. The review highlights the specificities of CVD in this population and the special considerations that need to be made in the management of these patients to maximize benefit and avoid futility. Another major objective is to find a contemporary definition of the elderly, including functional capacity and the concept of vascular, biological, and prospective age. A final aim is to review and discuss the definition and measurement of frailty and its impact on CVD management.
Lay Summary And Conclusions:
The key points are that old and very old people are a peculiar growing population across the globe, in which CVDs have a different impact and epidemiology compared with young people. Among CVDs, HF is clearly the most relevant and impactful on the quantity and quality of life. Each time we approach an elderly patient, a frailty multidisciplinary evaluation should be conducted, especially to avoid futile and aggressive invasive approaches with a risk-benefit balance in favour of harm.
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