Chronological vs Biological Age in Interventional Cardiology: A Comprehensive Approach to Care for Older Adults: JACC Family Series

Abstract

Aging is the gradual decline in physical and physiological functioning leading to increased susceptibility to stressors and chronic illnesses, including cardiovascular disease. With an aging global population, in which 1 in 6 individuals will be older than 60 years by 2030, interventional cardiologists are increasingly involved in providing complex care for older individuals. Although procedural aspects remain their main clinical focus, interventionalists frequently encounter age-associated risks that influence eligibility for invasive care, decision making during the intervention, procedural adverse events, and long-term management decisions. The unprecedented growth in transcatheter interventions, especially for structural heart diseases at extremes of age, have pushed age-related risks and implications for cardiovascular care to the forefront. In this JACC state-of-the-art review, the authors provide a comprehensive overview of the aging process as it relates to cardiovascular interventions, with special emphasis on the difference between chronological and biological aging. The authors also address key considerations to improve health outcomes for older patients during and after their invasive cardiovascular care. The role of "gerotherapeutics" in interventional cardiology, technological innovation in measuring biological aging, and the integration of patient-centered outcomes in the older adult population are also discussed.

Keywords: age-associated risks; aging; cardiovascular disease; risk factors; transcatheter therapeutics.

FIGURE 1

Priorities for the Older Adult Population Undergoing Cardiovascular Interventions This figure provides a forward-looking perspective on older patients undergoing percutaneous cardiovascular procedures. Key areas of emphasis include shared decision making, care pathways, the potential for artificial intelligence, and a focus on patient-centric outcomes. LOS = length of stay.

CENTRAL ILLUSTRATION

Special Considerations for TAVR in the Older Adult Population The figure details the essential elements required for preprocedural evaluation. It also highlights the negative prognostic markers, coexistence of multiple chronic conditions, and the importance for understanding patient goals and postprocedural expectations in older patients undergoing transcatheter aortic valve replacement (TAVR). DNR = do not resuscitate.