Top Things to Know: Older Adults in the Cardiac Intensive Care Unit: Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care
Published: December 09, 2019
- Older adults admitted to cardiac intensive care units (CICU) face age-related cardiovascular (CV) risks and associated geriatric syndromes, including delirium and cognitive impairment, frailty, multimorbidity and polypharmacy.
- The CICU environment of procedures, new medications, sensory overload, sleep deprivation, prolonged bedrest and malnourishment is inherently disruptive to older patients.
- This statement examines the intersection of CICU-related risks and geriatric vulnerabilities in older CICU patients, and emerging opportunities to enhance CICU care.
- Efforts to integrate geriatric syndromes into the CV care of older patients have lagged due to a lack of interventions in the CICU and because they may be perceived as less important than time-sensitive, disease-oriented urgencies.
- Strategies to achieve a holistic approach for each patient remain an important goal to improve care of older CICU patients. Frailty and cognitive decline, both as chronic and dynamic phenomena, are significant modifiers to therapeutic efficacy.
- The intrinsic association of acute cardiovascular disease (CVD) with geriatric complexities requires tailored approaches that fundamentally and clearly interconnect non-CVD geriatric domains.
- This statement discusses management of acute CVD in the context of geriatric complexities, including myocardial infarction, acute decompensated heart failure, acute valvular disease, acute aortic syndrome and pulmonary embolism.
- Shared decision making, end-of-life care, and palliative care services complement the care in the CICU and should be utilized to enhance management in older patients with acute CVD.
- Recognizing geriatric syndromes is a key first step in choosing care that is most likely to succeed and most consistent with each patient’s personal care needs.
- When caring for an older patient with acute CVD, a thoughtful approach to critical care management requires consideration for geriatric syndromes as well as initiatives to integrate these syndromes in the overall CICU models of care.
Citation
Damluji AA, Forman DE, van Diepen S, Alexander KP, Page RL 2nd, Hummel SL, Menon V, Katz JN, Albert NM, Afilalo J, Cohen MG, on behalf of the American Heart Association Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing. Older adults in the cardiac intensive care unit: factoring geriatric syndromes in the management, prognosis, and process of care: a scientific statement from the American Heart Association [published online ahead of print December 9, 2019]. Circulation. doi: 10.1161/CIR.0000000000000741.