A Call for Collaboration: Improving Cardiogeriatric Care

With the population aging, there is an exponential increase in the prevalence of cardiovascular disease (CVD). Congestive heart failure (CHF) is considered the "poster child" of the blend of CVD, multi-morbidity, and frailty in the aging population. Traditionally, from the cardiologist's point of view, the top multimorbidities in CHF are hypertension, ischemic heart disease, hyperlipidemia, anemia, and diabetes. However, the care of these patients is confounded by common geriatric conditions (multimorbidity, dementia, medication intolerance, frailty) contributing to functional disability, reduced quality of life, and increased hospitalization. Given a 3-fold increase in the number of patients with CHF within the next couple of decades, we must act now. We need to address complex care coordination and integrated disease management as part of the continuum of care, including advance directives and patient preferences. Research and educational curricula must address clinical practice guidelines appropriate for the frail elderly with multimorbidities. Improved care of the older patient with cardiac disease is dependent on a new model of collaboration and teamwork between primary care physician, geriatrician, and cardiologist to accommodate the fundamental heterogeneity of aging and the patients' choices. Collaborative cardiogeriatric clinics have started. The goal of these clinics is to provide integrated care and education for older patients and their caregivers, with the objective of improving quality of life and function. These clinics are also designed to build educational capacity for medical trainees and provide an ongoing research environment. This prototype of a sustainable model will be used to assess methods by which cardiogeriatric clinics could be introduced into standard clinical medical practice.