While there is plenty of literature for risk prediction of cardiovascular disease and preventive therapies, risk estimates are less well known for patients aged > 80 years. There is a need to address this gap in knowledge, as the health status of very elderly people will increasingly impact on health care.

A detailed study carried out in Beijing by Zhu et al., published in this journal, describes the 5-year risk of cardiovascular disease in 724 very elderly Chinese patients – all > 80 years old, most of them men. They were admitted to the geriatric cardiology department, something that is an evolving field at the international level. The reasons for hospital admission were mostly related to coronary artery disease and hypertension control; only a few were admitted for respiratory or digestive tract disease. After a median follow-up of 5.3 years and a follow-up rate of 98%, about 50% of the patients died, most of them from infections and only 1 in 16 patients from a cardiac cause. The study shows that cardiovascular morbidity and all-cause mortality risk in this population can be successfully predicted by the N-terminal pro-B-type natriuretic peptide levels (NT-proBNP).

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The essence of geriatric cardiology

Because it is a recent and not widespread specialty, Geriatric Cardiology is often confused with Geriatrics that is practiced by a cardiologist or simply with Cardiology that is applied to elderly patients. Although this is part of the discipline’s core, it does not represent the whole picture. It would be more adequate to define it as integrated and age-adequate cardiovascular care, centered on the patients and their functionalities – a concept previously presented by our colleagues^,– that has been evolving and taking shape, as a result of the use of specific and predetermined tools.

Objectively, one could consider it as cardiology practice integrated with the Geriatric’s 5 Ms: medication (focusing on prescribing the absolutely necessary, targeting at reducing polypharmacy, minimizing interactions and adverse reactions; following Beers criteria to select appropriate medication for the elderly), mentation (vigilance, prevention and treatment of cognitive disturbances), mobility (valuing and implementing strategies that seek to maintain the patient’s mechanical functionality), multimorbidity (approaching the patient not only by looking up the cardiovascular system, but also by considering the occurrence of multiple comorbidities to be the rule, not the exception, in these individuals), and last, but literally not least is matters most (always consider the patient’s opinion regarding the benefits and burdens of the treatment, taking into account the biography and personal values, bringing the patient into the center of decision making). We would also add a sixth and last M, multidisciplinary, for the care of the elderly, remembering it must be coordinated in a horizontal fashion by a professional, but never concentrated in only one person, giving due importance to the participation of other specialists and healthcare professionals. At our institute, in the Geriatric Cardiology Unit, we perform in all patients a Comprehensive Geriatric Assessment with the aid of the 10-TaGA (10-Minute Targeted Geriatric Assessment) tool.^,

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