ACC Geriatric Council Discusses Framework For Care of Older HF Patients

By embracing a domain-management approach that addresses unique multidimensional needs and vulnerabilities, clinicians may improve health outcomes for older adults with heart failure (HF), according to an ACC Geriatric Council Perspective published April 23 in the Journal of the American College of Cardiology.

In order to aid clinicians in managing the vulnerable and complex older HF population, Eiran Z. Gorodeski, MD, MPH, FACC, et al., discuss a four-dimensional framework with approaches such as medical, mind and emotions, physical function and social environment. They explain that this framework is crucial as HF is a typical geriatric cardiovascular condition, with more than 50 percent of hospitalizations occurring in adults age 75 years or older.

The medical domain approach incorporates conditions and syndromes commonly encountered in older adults with HF. In addition to evaluation of the etiology, stage and chronicity of HF, the authors point out that clinicians caring for older HF patients must also consider their multimorbidity, polypharmacy and nutritional status. "These conditions are not only common, but essential aspects of HF in older patients with important implications on management and prognosis," the authors write.

The authors also point out the importance of the mind and emotion domain approach, which includes the intersection between cognition and emotional brain function with the ability to manage HF. They note that failure to recognize conditions such as cognitive impairment and depression may lead to future problems in communication and self-care, and that it is crucial for clinicians to consider these conditions in adults with HF.

Furthermore, the physical function domain approach encompasses a person's ability to perform a variety of complex physical activities ranging from basic (bathing and dressing) to advanced (preparing meals, managing medications and driving), and includes the risk for falls. The authors note that clinicians caring for older adults with HF should know their patients' baseline functional status, as any change from baseline is important when evaluating new symptoms and changes in condition.

The fourth domain is the social environment approach, which includes paying attention to factors affecting an individual's life outside of the clinic or hospital setting. Clinicians caring for older HF patients may benefit from insights into patients' physical and social living environments such as psychological and financial burdens. The authors explain that it is important to inquire about the level of social support at home and encourage patients to consider engaging in community-based programs.

The authors conclude that "the aging U.S. population, ongoing epidemic of chronic diseases with HF at the helm and shifts in health care from volume to value suggest that care of this population by cardiologists and other cardiovascular providers will become increasingly commonplace." They add, "There is an emerging need for cardiovascular providers to develop requisite knowledge and skills that fall outside of most providers' comfort zone and the traditional paradigm of cardiovascular training."

Keywords: Self Care, Accidental Falls, Depression, Nutritional Status, Syndrome, Chronic Disease, Polypharmacy, Hospitalization, Risk, Exercise, Heart Failure, Social Support, Social Environment, Prognosis, Brain

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