RESUMO
The death of C. Richard Conti, MD, MACC in February 2022 marked the passing of a global leader in cardiology who played a pivotal role in the history of the American College of Cardiology and the College's outreach to the People's Republic of China.
Assuntos
Cardiologia , Cooperação Internacional , Humanos , Cardiologia/história , China , Estados Unidos , Cooperação Internacional/históriaRESUMO
Shared decision-making is appropriate for clinical decisions involving multiple reasonable options, which occur frequently in the cardiovascular care of older adults. The process includes the communication of relevant factual information between the patient and the clinician, elicitation of patient preferences, and a mutual agreement on the best course of action to meet the patient's personal goals. For older adults, there are common challenges and considerations with regard to shared decision-making, some of which (eg, cognitive impairment) may be biologically linked to cardiovascular disease. There are tools designed to facilitate the shared decision-making process, known as decision aids, which are broadly effective although have shortcomings when applied to older adults. Novel approaches in clinical research and health systems changes will go some way toward improving shared decision-making for older adults, but the greatest scope for improvement may be within the grass roots areas of communication skills, interdisciplinary teamwork, and simply asking our patients what matters most.
Assuntos
Envelhecimento/psicologia , Doenças Cardiovasculares/terapia , Tomada de Decisão Compartilhada , Conhecimentos, Atitudes e Prática em Saúde , Participação do Paciente , Relações Médico-Paciente , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Técnicas de Apoio para a Decisão , Feminino , Comunicação em Saúde , Humanos , Masculino , Assistência Centrada no PacienteAssuntos
Cardiologia/normas , Padrões de Prática Médica/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Cardiologia/economia , Cardiologia/legislação & jurisprudência , Redução de Custos , Fraude/prevenção & controle , Regulamentação Governamental , Custos de Cuidados de Saúde/normas , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Humanos , Formulação de Políticas , Padrões de Prática Médica/economia , Padrões de Prática Médica/legislação & jurisprudência , Melhoria de Qualidade/economia , Melhoria de Qualidade/legislação & jurisprudência , Indicadores de Qualidade em Assistência à Saúde/economia , Indicadores de Qualidade em Assistência à Saúde/legislação & jurisprudência , Sociedades Médicas/normasRESUMO
The population of older adults is expanding rapidly, and aging predisposes to cardiovascular disease. The principle of patient-centered care must respond to the preponderance of cardiac disease that now occurs in combination with the complexities of old age. Geriatric cardiology melds cardiovascular perspectives with multimorbidity, polypharmacy, frailty, cognitive decline, and other clinical, social, financial, and psychological dimensions of aging. Although some assume that a cardiologist may instinctively cultivate some of these skills over the course of a career, we assert that the volume and complexity of older cardiovascular patients in contemporary practice warrants a more direct approach to achieve suitable training and a more reliable process of care. We present a rationale and vision for geriatric cardiology as a melding of primary cardiovascular and geriatrics skills, thereby infusing cardiology practice with expanded proficiencies in diagnosis, risks, care coordination, communications, end-of-life, and other competences required to best manage older cardiovascular patients.