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<\/p>\nFebruary is a fitting month to celebrate American Heart Month, and there\u2019s much to celebrate: smoking rates are down; understanding of the importance of exercise and diet is up; and new, diverse medications help to prevent and treat cardiovascular disease.<\/p>\n
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There\u2019s also a world of new life-saving technologies and procedures such as wearable defibrillators and percutaneous coronary interventions, along with valve replacements and bypass surgeries, which seem almost old-hat, by now.<\/p>\n
Yet heart disease is still the leading cause of death for men and women in the US, with 1 in 4 deaths due to heart disease.<\/p>\n
Prevalence of cardiovascular disease increases with age, and in older adults, even routine cardiovascular treatments must be used with caution.<\/strong><\/p>\n \u201cWith heart health especially, you have to look at patients\u2019 goals of care: are you looking to alleviate symptoms or improve function, or are you trying to live longer?\u201d says Beth Rosenberg, MD, EdD, FACC, a primary care provider for Piedmont Health Services\u2019 Burlington PACE center as well as the \u201chouse cardiologist\u201d for the Burlington and Pittsboro PACE centers.<\/p>\n At PACE, the federally funded Program of All-Inclusive Care for the Elderly, these conversations around goals of care happen every day, says Rosenberg, but are not practiced so widely in the larger community.<\/p>\n With 20 years in cardiology practice in the Triangle, Dr. Rosenberg knows about hearts. As a cardiologist, she found caring for her older patients very rewarding. Her work with older patients at PACE combines her cardiology background and general medicine skills with a passion for caring for older adults.<\/p>\n Interprofessional Geriatric Fellowship Program <\/strong><\/p>\n Dr. Rosenberg is also a current Fellow in the Division of Geriatric Medicine\u2019s Interprofessional Geriatric Fellowship Program, where she continues to learn about geriatric medicine from multiple perspectives of pharmacy, nursing, and dentistry, while sharing her cardiology expertise. The IP Geriatric Fellowship brings providers from different disciplines together for a one-year program of shared expertise and geriatric focus.<\/p>\n Decisions regarding prevention and treatment of cardiovascular disease are more challenging with older patients, who have multiple chronic conditions and take more medications. Care can be further complicated by the lack of research and guidelines specifically for patients over 75.<\/p>\n \u201cThe problem with cardiology guidelines is that none of them apply to my patients,\u201d says Dr. Rosenberg. \u201cBlood pressure can be a whole conundrum, in and of itself.\u201d<\/p>\n Statins in older patients are also a topic of considerable debate.\u00a0<\/strong><\/p>\n For older adults with hypertension and diabetes, it might make sense to be on statins. But if taking statins brings muscle pain and means a patient has a hard time getting up in the morning, \u201cthat\u2019s not worth it,\u201d says Dr. Rosenberg. In adults 75 and over, it may be reasonable to discontinue statins where there is functional decline or reduced life expectancy, she says.<\/p>\n When considering heart surgery for older patients, Dr. Rosenberg says that \u201cmuch of the time it goes well, but when it doesn\u2019t, it goes very poorly.\u201d Patients over 80 require a different discussion, with full consideration of complicating factors. For patients in their 80s, particularly those who are frail and living with COPD, diabetes, or kidney disease, surgery brings real potential for harm.<\/p>\n Older people metabolize anesthesia differently. In cases of borderline dementia, \u201cif you send them for surgery, they may not come out better.\u201d Dr. Rosenberg says that some older patients can be good candidates for surgery, but the key to successful outcomes is selecting good candidates. Dr. Rosenberg\u2019s heart health advice for those between 55 and 75 years of age is to use available care and treatment options to decrease risk of cardiovascular disease, provided they don\u2019t negatively impact quality of life.<\/p>\n \u201cBeing older is the time in one\u2019s life when the balance of risks or negative impacts of various drugs or interventions on quality of life may start to outweigh benefits.\u201d<\/p><\/blockquote>\n Regular, safe exercise \u2013 supported and monitored for vulnerable patients \u2013 and a heart-healthy diet may well be the best \u201cmedicine\u201d for old and young hearts alike.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":"![\"Dr.](\"https:\/\/www.med.unc.edu\/aging\/wp-content\/uploads\/sites\/753\/2019\/02\/IPEFellowsRobot_C-282x300.jpg\")