Bringing the pieces together: Integrating cardiac and geriatric care in older patients with heart disease: Integrating cardiac and geriatric care in older patients with heart disease

Due to the increasing aging population, the number of older cardiac patients is also expected to rise in the next decades. The treatment of older cardiac patients is complex due to the simultaneously presence of comorbidities and polypharmacy, and geriatric conditions such as functional impairment, fall risk and malnutrition. However, the assessment of geriatric conditions is not part of the medical routine in cardiology and therefore these conditions are frequently unrecognized although they have a significant impact on treatment and on outcomes. In addition, treatments are mostly based on single-disease oriented guidelines and inadequately take other conditions into account. This may lead to conflicting recommendations and treatments that do not address important outcomes for older patients such as daily functioning, symptom relief and quality of life. Thus, the care of older cardiac patients is currently suboptimal which increases the risk of functional loss, readmission and mortality.
The overall aim of the work described in this thesis is to explore the integration of cardiac and geriatric care for older patients with heart disease. First, by examining how hospitalized older cardiac patients at high risk for adverse events could be identified. Second, by investigating lifestyle-related secondary prevention of cardiovascular complications in older cardiac patients. And third, by developing a transitional care intervention for older cardiac patients and evaluating the effect on unplanned hospital readmission and mortality.