Improving Cardiovascular Care for Frail Older People

Frailty and cognitive impairment are closely linked to cardiovascular diseases. International guidelines on cardiovascular care emphasize the importance of assessing these conditions in older people. Yet, clear recommendations on the assessment of frailty and cognitive impairment, as well as how to adjust treatment plans accordingly, are still lacking. The main aim of this thesis was to investigate how cardiovascular care can be tailored to meet the needs of the growing population of frail older people. In Part 1, we examined how frailty and cognitive impairment can be addressed in patients with heart failure, focusing on a care pathway centred around a comprehensive geriatric assessment and its potential to improve patient outcomes. We demonstrated that systematic screening for cognitive impairment in older patients with heart failure, as well as collaboration with (internist-)geriatricians, is supported by cardiologists. Furthermore, we showed that performing a comprehensive geriatric assessment in selected heart failure patients can result in quality of life improvement for patients and their caregivers. In addition, we demonstrated the high current costs of outcomes that a comprehensive geriatric assessment could potentially impact. In Part 2, we examined the adjustment of cardiovascular disease treatment in the context of frailty and cognitive impairment. We performed an external validation of the SCORE2-OP algorithm for predicting cardiovascular mortality in frail geriatric outpatients and concluded that SCORE2-OP can be a valuable tool for cardiovascular risk estimation in frail older people without a history of atherosclerotic cardiovascular diseases. Additionally, we evaluated current guidelines, research evidence, and expert opinions on cardiovascular risk management in people with dementia, and developed practical guidance to assist caregivers in applying these strategies in patient care. Finally, we conducted a systematic review of the existing literature on the efficacy and safety of heart failure treatment across different levels of frailty. Our findings indicated that heart failure treatment is safe and appears to provide at least similar benefits in frail heart failure patients compared to non-frail patients. This thesis highlights the growing challenges of managing cardiovascular diseases in an ageing society and emphasizes that a one-size-fits-all approach is insufficient. It provides practical frameworks for frailty and cognitive screening, and proposes strategies to individualize and tailor care to meet each frail patient’s unique needs.