Ikigai in aging hearts: Japan's approach to cardiovascular care

The global population is aging rapidly, creating a growing demand for cardiovascular care that is better aligned with the complex comorbidities and diverse life contexts of older adults. The 5Ms of geriatrics-Mind, Mobility, Medications, Multicomplexity, and What Matters Most-provide a practical framework to individualize treatment strategies based on functional status, comorbidities, and patient values (ikigai). This review explores how integrating the 5Ms into the management of hypertension, atrial fibrillation, and heart failure can guide clinical decision-making in aging societies. We highlight practical strategies, such as deprescribing, fall risk assessment, and shared decision-making, that tailor care to patient priorities. Furthermore, we discuss policy implications, including the need for greater incentives for comprehensive geriatric assessments and advance care planning. Since evidence-based guidelines may not fully capture the complexity of older patients, incorporating the 5Ms and comprehensive assessments can support patient-centered care and help build evidence based on meaningful outcomes in aging societies. Balancing EBM and Ikigai in Aging Hearts The figure highlights how the 5Ms of geriatrics guides patient-centered decision-making. EBM evidenced based medicine.