4 chambers of the heart: right atrium, right ventricle, left atrium, left ventricle.

Treating more than just the heart is critical for geriatric patients

News Release, American Heart Association

Statement Highlights:

  • Geriatric conditions such as frailty, cognitive impairment, taking multiple medications and having multiple medical conditions complicate care for older people with acute cardiovascular diseases.
  • Most research on how to treat acute cardiovascular conditions was conducted with younger people and may not apply to older patients.

DALLAS, Dec. 9, 2019 — Geriatric conditions such as frailty and cognitive impairments may inadvertently worsen when older patients are treated in cardiac intensive care units – even as they receive excellent care for their heart attackheart failurevalvular heart disease or pulmonary embolism, according to a new scientific statement from the American Heart Association, published today in the Association’s premier journal Circulation.

In addition to their cardiovascular conditions, many older patients often have additional health conditions, take multiple medications for these conditions, may be frail or have cognitive impairment. Caring for older adults in the cardiac intensive care unit is markedly different than caring for younger patients, according to the statement, which provides an overview of how geriatric conditions may influence acute cardiovascular care.

“Treating the whole patient – considering their entire health profile, rather than focusing only on their acute cardiovascular event – is essential for achieving the best possible outcomes among geriatric patients with acute cardiovascular disease,” said Abdulla A. Damluji, M.D., M.P.H., chair of the writing group for the statement, assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland, and interventional cardiologist at the Inova Heart and Vascular Institute, Falls Church, Virginia.  

While in a cardiac intensive care unit, older patients often experience factors that are emotionally and physically disorienting – such as bright lights, excessive noise, new medications, urinary catheters, dietary shifts, sleep disruptions, and toileting challenges. “For vulnerable older adults who may already be experiencing cognitive decline, the environment in the cardiac intensive care unit may deplete already limited coping skills and could lead to delirium,” said Damluji.  

Delirium is a state of an acute disturbance in awareness and attention. It commonly occurs during critical illness, and it contributes to a higher risk of dying in the hospital. “Reducing the level of sedation used in older patients may help mitigate delirium, however, more research needs to be done to fully understand how best to treat this condition in the context of acute cardiovascular illness,” said Damluji.

Extended bed rest, often necessary in an intensive care unit, is detrimental to patients of all ages. For older, critically ill patients, who are often frail when admitted to the cardiac intensive care unit, bedrest can significantly worsen their frailty. Further deterioration in muscle strength and bone density often occurs with prolonged immobility, which can also lead to poor medication tolerance, an increased risk of falling, weakened heart function and pressure ulcers (bed sores).

Early mobilization – getting the patient out of bed as soon as appropriate, may be helpful for some patients to address frailty. Encouraging appropriate physical movement may result in less weakness, an improved ability to walk and less time in the cardiac intensive care unit, among other benefits.

Another issue faced by older adults admitted to the cardiac intensive care unit is that they take an average of 12 different prescription medications, raising the risk of adverse side effects, drug-to-drug, and drug-to-disease interactions. Patients may benefit by having some of their medications discontinued or deprescribed, if appropriate.

“In recent years, there has been a strong emphasis by the American Heart Association and other organizations to integrate geriatric syndromes into cardiovascular care for older patients, although the implementation is slow. Strategies to achieve a holistic care approach for each patient remains an important goal to improve the care of older patients in the cardiac intensive care unit,” said Damluji.

Most clinical trials on how to treat acute cardiovascular conditions were performed on younger populations, however, their findings may not be accurate for older patients. Yet, most people over age 85 years have cardiovascular disease and are likely to be admitted to a cardiac intensive care unit for treatment of an acute event, according to the statement. 

Co-authors and members of the writing committee are: Co-Chair, Daniel E. Forman, M.D.; Sean van Diepen, M.D., M.Sc.; Karen P. Alexander, M.D.; Robert L. Page, II, Pharm.D., M.S.P.H.; Scott L. Hummel, M.D., M.S.; Venu Menon, M.D.; Jason N. Katz, M.D., M.H.S.; Nancy M. Albert, Ph.D.; Jonathan Afilalo, M.D., M.Sc.; Mauricio G. Cohen, M.D. Author disclosures are in the manuscript.

Additional Resources:

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at https://www.heart.org/en/about-us/aha-financial-information.


The Southern Maryland Chronicle is a local, small business entrusted to provide factual, unbiased reporting to the Southern Maryland Community. While we look to local businesses for advertising, we hope to keep that cost as low as possible in order to attract even the smallest of local businesses and help them get out to the public. We must also be able to pay employees(part-time and full-time), along with equipment, and website related things. We never want to make the Chronicle a “pay-wall” style news site.

To that end, we are looking to the community to offer donations. Whether it’s a one-time donation or you set up a reoccurring monthly donation. It is all appreciated. All donations at this time will be going to furthering the Chronicle through hiring individuals that have the same goals of providing fair, and unbiased news to the community. For now, donations will be going to a business PayPal account I have set-up for the Southern Maryland Chronicle, KDC Designs. All business transactions currently occur within this PayPal account. If you have any questions regarding this you can email me at davidhiggins@southernmarylandchronicle.com

Thank you for all of your support and I hope to continue bringing Southern Maryland the best news possible for a very long time. — David M. Higgins II




© 2019 The Southern Maryland Chronicle. All Rights Reserved. This website is not intended for users located within the European Economic Area.