High Prevalence of Geriatric Conditions Among Older Adults With Cardiovascular Disease

Abstract

As the population ages, the global cardiovascular disease burden will continue to increase, particularly among older adults. Increases in life expectancy and better cardiovascular care have significantly reshaped the epidemiology of cardiovascular disease and have created new patient profiles. The combination of older age, multiple comorbidities, polypharmacy, frailty, and adverse noncardiovascular outcomes is challenging our routine clinical practice in this field. In this review, we examine noncardiovascular factors that statistically interact in a relevant way with health status and quality of life in older people with cardiovascular disease. We focused on specific geriatric conditions (multimorbidity, polypharmacy, geriatric syndromes, and frailty) that are responsible for a major risk of functional decline and have an important impact on the overall prognosis in this patient population.

Keywords: aging; older adults; cardiovascular disease; clinical decision‐making; frailty; geriatric cardiology; geriatric syndrome; polypharmacy.

Figure 1. Conceptual Definition of Geriatric Syndrome.

Geriatric syndromes result from the cumulative, synergistic effects of discrete diseases on multiple organ systems; when the body can no longer compensate, the effects are finally expressed as a single symptom. The cumulative system impairments result in impaired function. When these impairments accumulate or when additional stress is present, function is lost and a geriatric syndrome develops. The accumulation of geriatric syndromes leads to an overall premorbid state (ie, frailty).

Figure 2. Factors Involved in the Management of CVD in Older Adults.

Care of older patients with CVD should include a comprehensive assessment and risk stratification: (1) management of the CVD (not just the diagnosis and treatment of cardiac complications), and (2) identification, prevention, and treatment of noncardiovascular geriatric conditions. Older patients who might benefit from more invasive interventions could be identified by leveraging the wealth of experience accumulated by geriatricians. CVD indicates cardiovascular disease; and QOL, quality of life.