Who Should Be the Cardiogeriatrician? A Competency-Based Perspective for an Ageing Cardiovascular Population

Background: Population ageing is reshaping cardiovascular medicine, with older adults increasingly presenting with heart failure, atrial fibrillation, and structural heart disease. Their management is frequently complicated by frailty, multimorbidity, functional impairment, and competing priorities, challenging traditional disease-centred cardiovascular models. Objective: To address who should act as the cardiogeriatrician using a competency-based perspective focused on the clinical skills and decision-making capacities required to care for older frail adults. Methods: Narrative review of PubMed/MEDLINE literature integrating cardiology, geriatrics, and health services research, including guidelines, consensus statements, observational studies, and conceptual frameworks. Results: Cardiogeriatric care models vary widely and are often defined by professional roles rather than competencies. A competency-based framework better captures core requirements, including frailty-informed interpretation, proportionality of care, trajectory-based assessment, and goal-concordant decision-making. Cardiogeriatric expertise may be embodied by different professional profiles. One workable profile is a geriatrician with sustained cardiovascular practice and clearly defined competencies. Cardiology expertise remains essential for diagnostic confirmation, complex decision-making, and interventional care. Conclusions: A competency-based conceptualisation of cardiogeriatrics supports collaborative, proportionate, and patient-centred cardiovascular care in ageing populations, without redefining professional boundaries.