A series of research articles and a state-of-the-art review in JACC: Advances emphasize the challenges clinicians can face when working with older adult patients, addressing the relationship between dementia and other geriatric conditions and cardiovascular health, outlining the possible benefits of mobile health cardiac rehabilitation, and exploring the current and future landscape for cardiovascular imaging modalities in the geriatric population.

POAF and Incident Dementia

A retrospective cohort study of Medicare beneficiaries by Parag Goyal, MD, FACC, et al., found that postoperative atrial fibrillation (POAF) was associated with incident dementia in patients ≥66 years undergoing noncardiac surgery. Results among 670,745 patients showed that while incident dementia occurred at similar rates in cardiac surgical patients with and without POAF (4.4% vs. 4.6%), in noncardiac surgical patients, incident dementia occurred in 12.5% of those with vs. 9.3% in those without POAF (adjusted hazard ratio, 1.20). “Our findings suggest that POAF may be a marker of elevated risk or perhaps even an etiologic contributor for developing future dementia,” write the study authors.

ARIC: Geriatric Conditions Associated With MACE

There is a graded and synergistic association between the number of geriatric conditions and major adverse cardiovascular events (MACE), defined as myocardial infarction (MI), stroke and all-cause death, according to data from the ARIC study. More than half (63%) of the adult participants ≥65 years had three or more geriatric conditions, including sarcopenia, frailty, cognitive decline, multimorbidity, visual impairment, functional decline, polypharmacy, hearing impairment and urinary incontinence. Results showed that compared with those with no or one condition, those with five or more had a significantly greater risk of MI (odds ratio [OR], 4.62), stroke (OR, 6.03), death (OR, 3.12) and MACE (OR, 4.26), with multimorbidity contributing to the highest odds of MACE. “These results highlight the imperative for holistic, multidisciplinary care models that integrate geriatric and cardiology expertise to enhance risk prediction, support complex decision-making, and deliver targeted prevention and management strategies beyond conventional cardiovascular approaches,” write study authors Kehinde Tom-Ayegunle, MD, and colleagues.

RESILIENT: mHealth-CR For Cardiac Rehabilitation

According to an analysis of the RESILIENT trial by Elianna M. Shwayder, MD, et al., older adults (≥65 years) receiving mobile health cardiac rehabilitation (mHealth-CR) were more likely to exceed their personalized cardiac rehabilitation (CR) goals, as defined by goal attainment scaling (GAS; range of –2 to +2). While there were no significant differences in functional capacity, health status, angina or disability between 400 patients with ischemic heart disease (median age, 71; 27% women; 65% prefrail/frail) randomized to either mHealth-CR (n=298) or usual care (n=102), or in rates of attaining or exceeding goals (GAS ≥0; 81% vs. 78%; p=0.492), those in the treatment arm had higher rates of exceeding expected goal attainment (GAS +1, +2) compared with usual care (53% vs. 34%; p=0.006). “These findings underscore the potential of mHealth-CR to facilitate meaningful, patient-centered progress, even in the absence of differences in conventional clinical endpoints,” write the authors.

Noninvasive Cardiac Imaging in Older Adults

A state-of-the-art review by Krishna K. Patel, MD, MSc, et al., discussed the unique challenges that arise when using noninvasive cardiac imaging in older adults, breaking down both the strengths and limitations of several modalities, including transthoracic echocardiography, transesophageal echocardiography, stress echo, cardiac CT, cardiac MRI and nuclear imaging. They outline the most common barriers in image acquisition and explore future directions that could address key research gaps. More inclusive imaging trials, older adult-specific imaging guidelines, shared decision-making tools, protocol optimization, point-of-care imaging and artificial intelligence integration could be implemented and leveraged to address challenges in obtaining care in this population. “A multimodality, patient-centered approach that incorporates geriatric assessment can improve accuracy, guide care, and enhance outcomes,” the team concludes.

Want to explore these future directions for yourself? The Geriatric Cardiology Member Section offers additional resources and discussion on cardiovascular diagnosis and care of older adults.