Task Force on Geriatric Cardiology - ESC Council for Cardiology Practice

Geriatric cardiology is increasingly a subspecialty of cardiology, presenting specific peculiarities both in pathophysiology of cardiovascular (CV) ageing, diagnosis, management and treatment of (1,2).

Mission

The mission of this taskforce will be:

• to promote healthy ageing, particularly related to CVD prevention and appropriate management of risk factors in the elderly
• to focus on particular aspects of CVD in the elderly
• to implement appropriate management of CVD in the elderly
• to implement appropriate management of non-CV diseases associated with increased vascular risk in the elderly
• to focus on frailty in CVD
• to focus on CVD end-of-life issues
• to develop new strategies to support ageing and disease management in the elderly, for example using e-Health
• to promote ESC public health programmes and education as well as national education programmes
• translational research on cell ageing, particularly related to vascular ageing and heart cell ageing

Members

Members of this Taskforce are from Italy, France, Greece, Czechia, and Cyprus. In collaboration with other ESC Constituent Bodies the taskforce members participate in various educational initiatives in the field of geriatric cardiology both through national and international ESC webinars and meetings. Scientific documents are currently in publication on Frailty in Cardiology (European Journal of Preventive Cardiology, 2021) and Digital Health in older adults (coming soon).

According to the WHO “World report on ageing and health” documents, healthy ageing is “developing and maintaining the functional ability that enables well-being in older age.” Functional ability is determined by the intrinsic individual conditions (physical and mental status, medical status and multimorbidity) and environmental aspects (social and family support, environmental facilities) and the interactions among them (3).

CVDs account for a large part of morbidity and mortality in older adults and are one of the major medical domain-associated components of frailty (4,5). This complex multidimensional and multisystem condition is characterised by increased vulnerability to adverse stress and health events, often associated with multimorbidity. Frailty can contribute to an accelerated heart decline towards disability (defined as difficulty or dependency in carrying out activities essential for daily living, including tasks needed for self-care and living independently), thus greatly impacting on dailylife quality (5).

The aeging population is an increasing challenge for world health systems and major efforts are dedicated to maintain a healthy population. CVD prevention and appropriate management of risk factors in the elderly have a central role in delaying a frail condition and the ageing-related loss of independent living (5). However, although epidemiological data strongly support the need of CVD prevention in the elderly, peculiar clinical and pathophysiological aspects indicate to follow specific diagnostic target and therapeutic suggestions (5).
Moreover, CVD in older adults has unique features and distinguished needs, including goals focused on quality of life that should be shared with the patients promoting a successful interaction between the general cardiologist and care-givers. The scheduled interventional procedures and the pharmacological prescriptions should be tailored on the single patient, avoiding both to deprive older patients of consolidated therapies and to submit others to futile treatments.

COVID-19 brought a heavy health challenge in the elderly population with CVD having a central role on clinical outcomes in the acute phase of infection. Moreover, the late-COVID associated CV symptoms and signs should be recognised and properly followed in an ambulatory setting (6).

The recent explosion of new digital health approaches in general cardiology may be particularly useful in older patients, both in addressing self-caring for elderly patients with the aim of supporting their independency, in improving diagnosis and treatment of specific ageing-associated CV diseases such as heart failure and atrial fibrillation, and focusing on frailty management in CV patients (5). However, we must safeguard against ageism in the new ways that health care can be delivered, to avoid discriminations, for instance accounting for the need of legible applications and organising the new instruments to be used by the older population (7).
Geriatric cardiology emphasises the need to manage the patients using an individualised approach, rather than the disease, to centre stage with an increasing need to address the older adult population to fill the knowledge gaps, and to optimise the clinical approach in older adult CV care (8).

References

1. Bell SP, Orr NM, Dodson JA, Rich MW, Wenger NK, Blum K, Harold JG, Tinetti ME, Maurer MS, Forman DE. What to Expect From the Evolving Field of Geriatric Cardiology. J Am Coll Cardiol. 2015 Sep 15;66(11):1286-1299.

2. Miller AP, Maurer M, Alexander KP. Geriatric Cardiology: Two Decades of Progress and Strategy for the Future. J Am Coll Cardiol. 2018 Jun 26;71(25):2970-2973.

3. World report on ageing and health. Geneva: World Health Organization; 2015 (https://www.who.int/ageing/events/world-report-2015-launch/en/, accessed July 2021)

4. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, Bonny A, Brauer M, Brodmann M, Cahill TJ, Carapetis J, Catapano AL, Chugh SS, Cooper LT, Coresh J, Criqui M, DeCleene N, Eagle KA, Emmons-Bell S, Feigin VL, Fernández-Solà J, Fowkes G, Gakidou E, Grundy SM, He FJ, Howard G, Hu F, Inker L, Karthikeyan G, Kassebaum N, Koroshetz W, Lavie C, Lloyd-Jones D, Lu HS, Mirijello A, Temesgen AM, Mokdad A, Moran AE, Muntner P, Narula J, Neal B, Ntsekhe M, Moraes de Oliveira G, Otto C, Owolabi M, Pratt M, Rajagopalan S, Reitsma M, Ribeiro ALP, Rigotti N, Rodgers A, Sable C, Shakil S, Sliwa-Hahnle K, Stark B, Sundström J, Timpel P, Tleyjeh IM, Valgimigli M, Vos T, Whelton PK, Yacoub M, Zuhlke L, Murray C, Fuster V; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020 Dec 22;76(25):2982-3021. doi: 10.1016/j.jacc.2020.11.010. Erratum in: J Am Coll Cardiol. 2021 Apr 20;77(15):1958-1959.

5. Richter D, Guasti L, Walker D, Lambrinou E, Lionis C, Abreu A, Savelieva I, Fumagalli S, Bo M, Rocca A, Jensen MT, Pierard L, Sudano I, Aboyans V, Asteggiano R. Frailty in Cardiology: definition, assessment and clinical implications for general cardiology: a consensus document of the Council for Cardiology Practice (CCP), Association for Acute CardioVascular Care (ACVC), Association of Cardiovascular Nursing and Allied professions (ACNAP), European Primary Care Cardiology Society (EPCCS), European Association of Preventive Cardiology (EAPC), European Heart Rhythm Association (EHRA), Council on Valvular Heart Diseases (VHD), Council on Hypertension (CHT), Council of Cardio-Oncology (CCO), Working Group (WG) Aorta and Peripheral Vascular Diseases, WG e-Cardiology, WG Thrombosis, of the European Society of Cardiology. Eur J Prevent Cardiol. 2021, in press.

6. Richter D, Guasti L, Koehler F, Squizzato A, Nistri S, Christodorescu R, Dievart F, Gaudio G, Asteggiano R, Ferrini M. Late phase of COVID-19 pandemic in General Cardiology. A position paper of the ESC Council for Cardiology Practice. ESC Heart Fail. 2021 Jun 25.

7. WHO. Global report on ageism. World Health Organization, Geneva, Switzerland (2021) (https://www.who.int/publications/i/item/global-report-on-ageism, Accessed 18th Mar 2021)

8. Rich MW, Chyun DA, Skolnick AH, Alexander KP, Forman DE, Kitzman DW, Maurer MS, McClurken JB, Resnick BM, Shen WK, Tirschwell DL; American Heart Association Older Populations Committee of the Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council; American College of Cardiology; and American Geriatrics Society. Knowledge Gaps in Cardiovascular Care of the Older Adult Population: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society. Circulation. 2016 May 24;133(21):2103-22.