Open Access Review Article
Optimizing Cardiovascular Care in Aging
Populations: A Comprehensive Review of
Review began 07/01/2025
Geriatric Cardiology
Review ended 07/13/2025
Published 07/15/2025 Shreya Agarwal 1, Ifeoma N. Ozor 2, Siri Chithanuru 3, Enitan O. Odumosu 4, Olatunji E. Fadiora 5,
Glory Ikwan 6, Gopichand Bhanavath 7, Maaz Siddiqui 8, 9, Razia Sultana 10 , Sreedharan Murugesan 11 ,
© Copyright 2025
Agarwal et al. This is an open access article Esther O. Adebambi 12 , Ramsha Ali 13
distributed under the terms of the Creative
Commons Attribution License CC-BY 4.0.,
1. Internal Medicine, JSS Medical College, Mysore, IND 2. Family Medicine, University of Niš, Niš, SRB 3. Internal
which permits unrestricted use, distribution,
Medicine, Mamata Medical College, Khammam, IND 4. Internal Medicine, Caucasus International University, Tbilisi,
and reproduction in any medium, provided
the original author and source are credited.
GEO 5. Internal Medicine, Windsor University School of Medicine, Bassettere, KNA 6. Internal Medicine, New Vision
University, Tbilisi, GEO 7. Cardiac Anesthesiology, Fortis Memorial Research Institute, Gurgaon, IND 8. Psychology,
DOI: 10.7759/cureus.87992 Virginia Tech, Virginia, USA 9. Internal Medicine, American University of Antigua, Coolidge, ATG 10. Internal
Medicine, Anwer Khan Modern Medical College, Dhaka, BGD 11. Family Medicine, Coimbatore Medical College
Hospital, Coimbatore, IND 12. Internal Medicine, University of Limerick School of Medicine, Limerick, IRL 13. Medicine
and Surgery, Peoples University of Medical & Health Sciences for Women, Hyd, PAK
Corresponding author: Shreya Agarwal,
Abstract
A narrative review was conducted by searching recent literature in databases like Cochrane and PubMed,
using keywords such as “older adults”, “cardiovascular disease”, “frailty”, and “polypharmacy”. The
identified literature included cohort studies, scientific statements, systematic reviews, meta-analyses, and
narrative reviews from the last 15 years focusing on comprehensive care and recent evidence-based updates
in geriatric cardiology. Inclusion criteria of the aging population and the elderly with cardiovascular
conditions have been applied. The review excluded articles on pregnant women and children, studies on
animals, and articles not written in English. A thematic synthesis was conducted to identify key challenges
and strategies in geriatric cardiovascular care, focusing on multimorbidity, cognitive impairment, and
integrative care models. Our narrative review documents definitions, findings, recent updates and practical
approaches that can be implemented in geriatric practice addressing diagnostic and therapeutic challenges
in geriatric cardiology; disadvantages of traditional-disease focused models in elderly; frailty,
multimorbidity, polypharmacy and overcoming them; health inequities and disparities in cardiogeriatric
populations; and finally about some of the areas needing future researches and policies. The global rise in
the aging population has contributed to cardiovascular diseases (CVDs) becoming a dominant health
concern among older adults who often present with a range of coexisting conditions. These geriatric
syndromes complicate standard cardiovascular care, making collaborative multidisciplinary and patient-
centered strategies essential to improve health outcomes and functional independence. This narrative
review is aimed at exploring the efficacy of integrated, evidence-based multidisciplinary cardiovascular care
models on improving clinical outcomes and quality of life (QoL) among geriatric adults. The objective
evaluates and compares the impact of these models versus traditional practices, while also exploring key
challenges and recent innovations in cardiovascular care for aging populations.
Categories: Cardiology, Integrative/Complementary Medicine
Keywords: comprehensive geriatric assessment, geriatric cardiology, multidisciplinary treatments, multimorbidity
management, polypharmacy
Introduction And Background
As the global population continues to age rapidly, the current populations of 700 million aged 65 and older
are projected to double by 2050 and increase the burden of chronic diseases in the coming decades [1].
Cardiovascular diseases (CVDs) remain the leading cause of death in this demographic, yet older adults
present with clinical challenges such as multimorbidity, frailty, cognitive impairment, and polypharmacy, all
of which complicate standard cardiovascular care [2,3]. The complex interplay between these factors
underscores the need for a specialized, integrative approach to geriatric cardiovascular care. This brings
forth the central question: given the projected growth of the elderly population and the associated rise in
CVDs, what evidence-based strategies and integrative care models can be implemented to mitigate
cardiovascular risk and enhance the quality of life (QoL)?
By 2050, the aging population is predicted to increase by more than double to an unprecedented 1.5 billion.
It is a common misconception that geriatric care can be managed similarly to general adult care. However,
this review highlights the shortcomings of such an approach and emphasizes the necessity of a
multidisciplinary model that accounts for the intricate relationship between CVD and age-related conditions
[4,5]. Conventional treatment protocols often fail to address the nonlinear progression of comorbidities such
as diabetes, hypertension, and chronic kidney disease in older adults. These conditions, when coupled with
How to cite this article
Agarwal S, Ozor I N, Chithanuru S, et al. (July 15, 2025) Optimizing Cardiovascular Care in Aging Populations: A Comprehensive Review of
Geriatric Cardiology. Cureus 17(7): e87992. DOI 10.7759/cureus.87992
, age-related physiological changes like diminished cardiac function and increased vascular stiffness, demand
a more patient-centred strategy to achieve meaningful outcomes and address issues like polypharmacy. In
addition, elderly patients undergoing chemotherapy with agents such as anthracycline and trastuzumab
experience elevated cardiovascular risks as side effects. Arterial thromboembolism risk of 3.8% has been
observed on treatment with bevacizumab with chemotherapy (vs. 1.7% risk with chemotherapy alone). This
underscores the pressing need for more targeted clinical trials to fill existing knowledge gaps [6]. This aspect
of geriatric cardiology is critical yet often underexplored.
Geriatric care extends beyond the treatment of diseases. We need to focus on the integration of cardiac
rehabilitation and palliative care as well. While cardiac rehabilitation aims to restore cardiovascular health
post-event (e.g., after myocardial infarction or surgery), adherence rates among older adults remain low. At
the same time, early incorporation of palliative care, centered on symptom relief and QoL, can support
smoother transitions from acute care to hospice and improve overall patient well-being [7].
Moreover, advancements in technology and data collection are reshaping geriatric cardiology. Innovative
tools such as smart watches, home blood pressure monitors, augmented/mixed reality (AR/MR) in
interventional cardiology, and electronic patient-reported outcomes (ePROs) are gaining momentum [8,9].
However, their implementation raises questions about cost, ethics, and accessibility. Many older adults may
lack the skills, confidence, or resources to effectively use these technologies, potentially exacerbating
existing health inequities and limiting the benefits of digital innovation in vulnerable populations. To
further refine diagnostic and treatment practices, adjusted cardiac biomarkers and enhanced data systems
like the National Cardiovascular Data Registry (NCDR) and Practice Innovation and Clinical Excellence
Registry (PINNACLE) are becoming increasingly vital [10-12]. These data registries help assess the
effectiveness of various treatments and help improve the outcomes in cardiology therapy.
Ultimately, the study advocates for a holistic, interdisciplinary approach tailored to each individual. Shared
decision-making, factoring in medical, psychological, and social dimensions, can significantly elevate
patient satisfaction and care quality [13]. The significance of this review lies in its analysis of emerging
evidence and expert consensus on age-adapted cardiovascular assessment, therapeutic adaptation, and care
delivery. Key themes include individualized risk-benefit analysis, functional status assessment, and
personalized treatment planning for conditions such as heart failure, atrial fibrillation, and ischemic heart
disease in older adults [14].
In addition, it underscores the pivotal role of interdisciplinary collaboration in managing care transitions
and addressing the social determinants of health, which disproportionately affect aging populations. By
fostering collaboration among cardiologists, geriatricians, nurses, pharmacists, and social workers,
healthcare systems can better meet the complex needs of this demographic [15].
Beyond its clinical implications, the review also seeks to influence research priorities such as those related to
chemotoxicity or cardiac biomarkers, policy development, and a healthcare system design that focuses on a
patient-centred approach. Its broader impact lies in promoting care models that improve clinical outcomes,
support independence, reduce hospital readmissions, and ultimately enhance QoL for older adults [16].
Despite major advances in cardiology over the past decades, these improvements have not always translated
into better outcomes for older adults, whose health profiles are often heterogeneous and marked by
competing priorities [15,17].
Geriatric cardiology has emerged in response to these gaps, promoting a holistic, function-based perspective
[18]. Contemporary research emphasizes the need to integrate frailty assessments, cognitive evaluations,
and life expectancy considerations into clinical decision-making, factors traditionally overlooked in
standard care models. Moreover, aggressive interventions may not always align with older patients’ end-of-
life goals, further necessitating individualized and goal-concordant treatment plans [19].
This review extends these principles by synthesizing clinical evidence into actionable strategies for
optimizing cardiovascular care in aging populations. It explores diagnostic challenges, therapy
modifications, and the essential role of multidisciplinary care teams in maintaining independence and
navigating transitions. Understanding that care delivery is varied and dependent on multiple factors, the
review highlights the value of flexible, coordinated input from multiple specialties, offering system-level
insights to foster healthcare environments that uphold autonomy and dignity in older age. [20].To that end,
the study focuses on the delivery of cardiovascular care to older adults, particularly in the context of
prevalent conditions such as heart failure, arrhythmias, and ischemic heart disease [3,17]. It includes
updates on clinical guidelines, therapeutic innovations, and multidisciplinary care coordination [14,19].
Examples of both established practices and emerging areas of focus in geriatric cardiology are the discovery
of cardiac biomarkers elevated with age, the implementation of a patient-centered approach, a review of
chemotherapeutic drugs on cardiotoxicity, and much more.
This review also considers how physiological aging, frailty, and multimorbidity influence treatment
outcomes. By drawing on literature from the past decade, it identifies both effective practices and persistent
gaps in evidence, particularly for complex geriatric cases [20]. The ones dealing with a high cardiovascular
2025 Agarwal et al. Cureus 17(7): e87992. DOI 10.7759/cureus.87992 2 of 17
, burden. Let it be through toxicity or heart failure. Finally, it discusses how care delivery can shift toward
being more person-centered and preventive, with the aim of fostering sustainable, equitable models for an
aging world [21].
Review
Approximately 54 million Americans are over the age of 65 years, a number predicted to cross 81 million by
2040. Around three-quarters of adults, 65-79 years of age, are suffering from CVDs, making it the leading
cause of mortality [22]. However, since its diagnosis and management have advanced, the mortality rates in
patients with CVDs have become comparable to those in the general population. Therefore, noncardiac
etiologies are becoming more prevalent in the aged [23]. Endeavours to enhance general welfare in addition
to life expectancy in the aged suffering from CVD are being promoted.
Frailty, multimorbidity, and functional decline in cardiovascular aging
Frailty is a multidimensional syndrome marked by sarcopenia, weight loss, weakness, and reduced
endurance. It is characterized by diminished physiological reserves and increased vulnerability to stressors,
and is strongly associated with adverse cardiovascular outcomes, including heart failure, arrhythmias, and a
heightened risk of mortality [17,24]. Frailty has emerged as an independent risk factor for CVD. In various
studies, frailty has been associated with an increased risk of heart failure, myocardial infarction, stroke, and
peripheral arterial disease. However, frailty is considered to have a bidirectional relationship with CVD [22].
The theory of ‘Post-hospital syndrome’ posits that a combination of sleep deprivation, immobilization, and
disorientation leads to losses in various function domains (physical, psychological, social, etc.), rapidly
increasing the rate of frailty and ultimately bringing about a higher rate of readmissions and mortality. It is
of paramount importance to identify and manage frailty as it is a reversible and dynamic
condition. Assessing frailty or pre-frailty using validated tools such as the Frailty Index, Fried’s Phenotype,
or Essential Frailty Toolset can inform therapeutic decisions, emphasizing personalized care strategies [25].
Frailty not only worsens cardiovascular outcomes but also predisposes them to other chronic illnesses.
Comorbidities compound with aging, causing chronic inflammation and insufficient tissue repair, further
worsening CVD. Thus, multimorbidity, the coexistence of multiple chronic conditions, is highly prevalent in
older adults with CVDs. Conditions such as diabetes, chronic kidney disease, and cognitive impairment
interact with cardiovascular pathology, complicating treatment regimens [26]. Most of the current care
models are single-disease specific and do not acknowledge discordant conditions, despite their impact on
the overall outcome of patient satisfaction. However, the implementation of patient-centered care involves
targeting treatment based on the diverse needs of the older population, leading to increased quality of life,
rather than prolonging life with reduced functionality. This shifts the focus to the patient’s preferences,
giving them a chance in decision-making. The array of multimorbidity requires adaptation of contemporary
guidelines and incorporation of goal-oriented care [14,23].
Comorbidities cause limitations in activities of daily living and steepen the rate of physical and mental
debilitation. Declining functional capacity in elderly cardiac patients leads to reduced independence and
worsened prognosis. Impaired mobility, fatigue, and cognitive decline can limit adherence to treatments and
rehabilitation efforts. There is a considerable lack of knowledge regarding the prevalence, assessment, and
management of cognitive impairment in older adults with CVDs. The failing heart affects the cerebral
function, while impaired neuronal signals can impact the heart, leading to a reciprocal association, defined
as a “cardiocerebral syndrome” by Gorodeski et al. Studies have shown increased rates of 30-day hospital
readmissions in heart failure patients with cognitive decline [5]. Exercise-based interventions, cardiac
rehabilitation, and lifestyle modifications have shown promise in preserving functional and cognitive status
[27]. Tailoring interventions to the patient’s functional level, including screening for cognitive decline, can
optimize outcomes and maintain independence [28,29].
Frailty and multimorbidity both have a complex interplay with the cardiovascular system, leading to
accelerated functional decline in the elderly, as shown in Figure 1. Understanding and addressing these
interconnected conditions is essential for optimizing care in geriatric cardiology. Multimorbidity is also a
key factor of polypharmacy [4]. Although often necessary, polypharmacy introduces risks of adverse drug
reactions and treatment burden. All of these aspects, when combined, are detrimental if not intercepted
expeditiously. Older patients lean towards improved function over an extended life with decreased
activity. Integrating geriatric assessments into routine cardiology practice, promoting shared decision-
making, and incorporating palliative approaches when appropriate strikes a balance between the
standardised care and individualised care, centering on the requisites of the patient. According to the 2023
American Heart Association (AHA) Guideline for Management of Patients with Chronic Coronary Disease, a
patient-centered approach ensures effective communication to optimize outcomes and improve the QoL of
the patient. Geriatricians, who are acquainted with the patient’s goals of care, should be an integral part of
this team [5], as they provide a holistic approach.
2025 Agarwal et al. Cureus 17(7): e87992. DOI 10.7759/cureus.87992 3 of 17
Optimizing Cardiovascular Care in Aging
Populations: A Comprehensive Review of
Review began 07/01/2025
Geriatric Cardiology
Review ended 07/13/2025
Published 07/15/2025 Shreya Agarwal 1, Ifeoma N. Ozor 2, Siri Chithanuru 3, Enitan O. Odumosu 4, Olatunji E. Fadiora 5,
Glory Ikwan 6, Gopichand Bhanavath 7, Maaz Siddiqui 8, 9, Razia Sultana 10 , Sreedharan Murugesan 11 ,
© Copyright 2025
Agarwal et al. This is an open access article Esther O. Adebambi 12 , Ramsha Ali 13
distributed under the terms of the Creative
Commons Attribution License CC-BY 4.0.,
1. Internal Medicine, JSS Medical College, Mysore, IND 2. Family Medicine, University of Niš, Niš, SRB 3. Internal
which permits unrestricted use, distribution,
Medicine, Mamata Medical College, Khammam, IND 4. Internal Medicine, Caucasus International University, Tbilisi,
and reproduction in any medium, provided
the original author and source are credited.
GEO 5. Internal Medicine, Windsor University School of Medicine, Bassettere, KNA 6. Internal Medicine, New Vision
University, Tbilisi, GEO 7. Cardiac Anesthesiology, Fortis Memorial Research Institute, Gurgaon, IND 8. Psychology,
DOI: 10.7759/cureus.87992 Virginia Tech, Virginia, USA 9. Internal Medicine, American University of Antigua, Coolidge, ATG 10. Internal
Medicine, Anwer Khan Modern Medical College, Dhaka, BGD 11. Family Medicine, Coimbatore Medical College
Hospital, Coimbatore, IND 12. Internal Medicine, University of Limerick School of Medicine, Limerick, IRL 13. Medicine
and Surgery, Peoples University of Medical & Health Sciences for Women, Hyd, PAK
Corresponding author: Shreya Agarwal,
Abstract
A narrative review was conducted by searching recent literature in databases like Cochrane and PubMed,
using keywords such as “older adults”, “cardiovascular disease”, “frailty”, and “polypharmacy”. The
identified literature included cohort studies, scientific statements, systematic reviews, meta-analyses, and
narrative reviews from the last 15 years focusing on comprehensive care and recent evidence-based updates
in geriatric cardiology. Inclusion criteria of the aging population and the elderly with cardiovascular
conditions have been applied. The review excluded articles on pregnant women and children, studies on
animals, and articles not written in English. A thematic synthesis was conducted to identify key challenges
and strategies in geriatric cardiovascular care, focusing on multimorbidity, cognitive impairment, and
integrative care models. Our narrative review documents definitions, findings, recent updates and practical
approaches that can be implemented in geriatric practice addressing diagnostic and therapeutic challenges
in geriatric cardiology; disadvantages of traditional-disease focused models in elderly; frailty,
multimorbidity, polypharmacy and overcoming them; health inequities and disparities in cardiogeriatric
populations; and finally about some of the areas needing future researches and policies. The global rise in
the aging population has contributed to cardiovascular diseases (CVDs) becoming a dominant health
concern among older adults who often present with a range of coexisting conditions. These geriatric
syndromes complicate standard cardiovascular care, making collaborative multidisciplinary and patient-
centered strategies essential to improve health outcomes and functional independence. This narrative
review is aimed at exploring the efficacy of integrated, evidence-based multidisciplinary cardiovascular care
models on improving clinical outcomes and quality of life (QoL) among geriatric adults. The objective
evaluates and compares the impact of these models versus traditional practices, while also exploring key
challenges and recent innovations in cardiovascular care for aging populations.
Categories: Cardiology, Integrative/Complementary Medicine
Keywords: comprehensive geriatric assessment, geriatric cardiology, multidisciplinary treatments, multimorbidity
management, polypharmacy
Introduction And Background
As the global population continues to age rapidly, the current populations of 700 million aged 65 and older
are projected to double by 2050 and increase the burden of chronic diseases in the coming decades [1].
Cardiovascular diseases (CVDs) remain the leading cause of death in this demographic, yet older adults
present with clinical challenges such as multimorbidity, frailty, cognitive impairment, and polypharmacy, all
of which complicate standard cardiovascular care [2,3]. The complex interplay between these factors
underscores the need for a specialized, integrative approach to geriatric cardiovascular care. This brings
forth the central question: given the projected growth of the elderly population and the associated rise in
CVDs, what evidence-based strategies and integrative care models can be implemented to mitigate
cardiovascular risk and enhance the quality of life (QoL)?
By 2050, the aging population is predicted to increase by more than double to an unprecedented 1.5 billion.
It is a common misconception that geriatric care can be managed similarly to general adult care. However,
this review highlights the shortcomings of such an approach and emphasizes the necessity of a
multidisciplinary model that accounts for the intricate relationship between CVD and age-related conditions
[4,5]. Conventional treatment protocols often fail to address the nonlinear progression of comorbidities such
as diabetes, hypertension, and chronic kidney disease in older adults. These conditions, when coupled with
How to cite this article
Agarwal S, Ozor I N, Chithanuru S, et al. (July 15, 2025) Optimizing Cardiovascular Care in Aging Populations: A Comprehensive Review of
Geriatric Cardiology. Cureus 17(7): e87992. DOI 10.7759/cureus.87992
, age-related physiological changes like diminished cardiac function and increased vascular stiffness, demand
a more patient-centred strategy to achieve meaningful outcomes and address issues like polypharmacy. In
addition, elderly patients undergoing chemotherapy with agents such as anthracycline and trastuzumab
experience elevated cardiovascular risks as side effects. Arterial thromboembolism risk of 3.8% has been
observed on treatment with bevacizumab with chemotherapy (vs. 1.7% risk with chemotherapy alone). This
underscores the pressing need for more targeted clinical trials to fill existing knowledge gaps [6]. This aspect
of geriatric cardiology is critical yet often underexplored.
Geriatric care extends beyond the treatment of diseases. We need to focus on the integration of cardiac
rehabilitation and palliative care as well. While cardiac rehabilitation aims to restore cardiovascular health
post-event (e.g., after myocardial infarction or surgery), adherence rates among older adults remain low. At
the same time, early incorporation of palliative care, centered on symptom relief and QoL, can support
smoother transitions from acute care to hospice and improve overall patient well-being [7].
Moreover, advancements in technology and data collection are reshaping geriatric cardiology. Innovative
tools such as smart watches, home blood pressure monitors, augmented/mixed reality (AR/MR) in
interventional cardiology, and electronic patient-reported outcomes (ePROs) are gaining momentum [8,9].
However, their implementation raises questions about cost, ethics, and accessibility. Many older adults may
lack the skills, confidence, or resources to effectively use these technologies, potentially exacerbating
existing health inequities and limiting the benefits of digital innovation in vulnerable populations. To
further refine diagnostic and treatment practices, adjusted cardiac biomarkers and enhanced data systems
like the National Cardiovascular Data Registry (NCDR) and Practice Innovation and Clinical Excellence
Registry (PINNACLE) are becoming increasingly vital [10-12]. These data registries help assess the
effectiveness of various treatments and help improve the outcomes in cardiology therapy.
Ultimately, the study advocates for a holistic, interdisciplinary approach tailored to each individual. Shared
decision-making, factoring in medical, psychological, and social dimensions, can significantly elevate
patient satisfaction and care quality [13]. The significance of this review lies in its analysis of emerging
evidence and expert consensus on age-adapted cardiovascular assessment, therapeutic adaptation, and care
delivery. Key themes include individualized risk-benefit analysis, functional status assessment, and
personalized treatment planning for conditions such as heart failure, atrial fibrillation, and ischemic heart
disease in older adults [14].
In addition, it underscores the pivotal role of interdisciplinary collaboration in managing care transitions
and addressing the social determinants of health, which disproportionately affect aging populations. By
fostering collaboration among cardiologists, geriatricians, nurses, pharmacists, and social workers,
healthcare systems can better meet the complex needs of this demographic [15].
Beyond its clinical implications, the review also seeks to influence research priorities such as those related to
chemotoxicity or cardiac biomarkers, policy development, and a healthcare system design that focuses on a
patient-centred approach. Its broader impact lies in promoting care models that improve clinical outcomes,
support independence, reduce hospital readmissions, and ultimately enhance QoL for older adults [16].
Despite major advances in cardiology over the past decades, these improvements have not always translated
into better outcomes for older adults, whose health profiles are often heterogeneous and marked by
competing priorities [15,17].
Geriatric cardiology has emerged in response to these gaps, promoting a holistic, function-based perspective
[18]. Contemporary research emphasizes the need to integrate frailty assessments, cognitive evaluations,
and life expectancy considerations into clinical decision-making, factors traditionally overlooked in
standard care models. Moreover, aggressive interventions may not always align with older patients’ end-of-
life goals, further necessitating individualized and goal-concordant treatment plans [19].
This review extends these principles by synthesizing clinical evidence into actionable strategies for
optimizing cardiovascular care in aging populations. It explores diagnostic challenges, therapy
modifications, and the essential role of multidisciplinary care teams in maintaining independence and
navigating transitions. Understanding that care delivery is varied and dependent on multiple factors, the
review highlights the value of flexible, coordinated input from multiple specialties, offering system-level
insights to foster healthcare environments that uphold autonomy and dignity in older age. [20].To that end,
the study focuses on the delivery of cardiovascular care to older adults, particularly in the context of
prevalent conditions such as heart failure, arrhythmias, and ischemic heart disease [3,17]. It includes
updates on clinical guidelines, therapeutic innovations, and multidisciplinary care coordination [14,19].
Examples of both established practices and emerging areas of focus in geriatric cardiology are the discovery
of cardiac biomarkers elevated with age, the implementation of a patient-centered approach, a review of
chemotherapeutic drugs on cardiotoxicity, and much more.
This review also considers how physiological aging, frailty, and multimorbidity influence treatment
outcomes. By drawing on literature from the past decade, it identifies both effective practices and persistent
gaps in evidence, particularly for complex geriatric cases [20]. The ones dealing with a high cardiovascular
2025 Agarwal et al. Cureus 17(7): e87992. DOI 10.7759/cureus.87992 2 of 17
, burden. Let it be through toxicity or heart failure. Finally, it discusses how care delivery can shift toward
being more person-centered and preventive, with the aim of fostering sustainable, equitable models for an
aging world [21].
Review
Approximately 54 million Americans are over the age of 65 years, a number predicted to cross 81 million by
2040. Around three-quarters of adults, 65-79 years of age, are suffering from CVDs, making it the leading
cause of mortality [22]. However, since its diagnosis and management have advanced, the mortality rates in
patients with CVDs have become comparable to those in the general population. Therefore, noncardiac
etiologies are becoming more prevalent in the aged [23]. Endeavours to enhance general welfare in addition
to life expectancy in the aged suffering from CVD are being promoted.
Frailty, multimorbidity, and functional decline in cardiovascular aging
Frailty is a multidimensional syndrome marked by sarcopenia, weight loss, weakness, and reduced
endurance. It is characterized by diminished physiological reserves and increased vulnerability to stressors,
and is strongly associated with adverse cardiovascular outcomes, including heart failure, arrhythmias, and a
heightened risk of mortality [17,24]. Frailty has emerged as an independent risk factor for CVD. In various
studies, frailty has been associated with an increased risk of heart failure, myocardial infarction, stroke, and
peripheral arterial disease. However, frailty is considered to have a bidirectional relationship with CVD [22].
The theory of ‘Post-hospital syndrome’ posits that a combination of sleep deprivation, immobilization, and
disorientation leads to losses in various function domains (physical, psychological, social, etc.), rapidly
increasing the rate of frailty and ultimately bringing about a higher rate of readmissions and mortality. It is
of paramount importance to identify and manage frailty as it is a reversible and dynamic
condition. Assessing frailty or pre-frailty using validated tools such as the Frailty Index, Fried’s Phenotype,
or Essential Frailty Toolset can inform therapeutic decisions, emphasizing personalized care strategies [25].
Frailty not only worsens cardiovascular outcomes but also predisposes them to other chronic illnesses.
Comorbidities compound with aging, causing chronic inflammation and insufficient tissue repair, further
worsening CVD. Thus, multimorbidity, the coexistence of multiple chronic conditions, is highly prevalent in
older adults with CVDs. Conditions such as diabetes, chronic kidney disease, and cognitive impairment
interact with cardiovascular pathology, complicating treatment regimens [26]. Most of the current care
models are single-disease specific and do not acknowledge discordant conditions, despite their impact on
the overall outcome of patient satisfaction. However, the implementation of patient-centered care involves
targeting treatment based on the diverse needs of the older population, leading to increased quality of life,
rather than prolonging life with reduced functionality. This shifts the focus to the patient’s preferences,
giving them a chance in decision-making. The array of multimorbidity requires adaptation of contemporary
guidelines and incorporation of goal-oriented care [14,23].
Comorbidities cause limitations in activities of daily living and steepen the rate of physical and mental
debilitation. Declining functional capacity in elderly cardiac patients leads to reduced independence and
worsened prognosis. Impaired mobility, fatigue, and cognitive decline can limit adherence to treatments and
rehabilitation efforts. There is a considerable lack of knowledge regarding the prevalence, assessment, and
management of cognitive impairment in older adults with CVDs. The failing heart affects the cerebral
function, while impaired neuronal signals can impact the heart, leading to a reciprocal association, defined
as a “cardiocerebral syndrome” by Gorodeski et al. Studies have shown increased rates of 30-day hospital
readmissions in heart failure patients with cognitive decline [5]. Exercise-based interventions, cardiac
rehabilitation, and lifestyle modifications have shown promise in preserving functional and cognitive status
[27]. Tailoring interventions to the patient’s functional level, including screening for cognitive decline, can
optimize outcomes and maintain independence [28,29].
Frailty and multimorbidity both have a complex interplay with the cardiovascular system, leading to
accelerated functional decline in the elderly, as shown in Figure 1. Understanding and addressing these
interconnected conditions is essential for optimizing care in geriatric cardiology. Multimorbidity is also a
key factor of polypharmacy [4]. Although often necessary, polypharmacy introduces risks of adverse drug
reactions and treatment burden. All of these aspects, when combined, are detrimental if not intercepted
expeditiously. Older patients lean towards improved function over an extended life with decreased
activity. Integrating geriatric assessments into routine cardiology practice, promoting shared decision-
making, and incorporating palliative approaches when appropriate strikes a balance between the
standardised care and individualised care, centering on the requisites of the patient. According to the 2023
American Heart Association (AHA) Guideline for Management of Patients with Chronic Coronary Disease, a
patient-centered approach ensures effective communication to optimize outcomes and improve the QoL of
the patient. Geriatricians, who are acquainted with the patient’s goals of care, should be an integral part of
this team [5], as they provide a holistic approach.
2025 Agarwal et al. Cureus 17(7): e87992. DOI 10.7759/cureus.87992 3 of 17
