番茄社区

There is a need to better take care of geriatric patients in cardiac intensive care units (ICUs), where cardiovascular disease (CVD) care may be offset by worsening age-related conditions, according to a statement from the American Heart Association (AHA).

"The CICU [cardiac ICU] environment of procedures, new medications, sensory overload, sleep deprivation, prolonged bed rest, malnourishment, and sleep is usually inherently disruptive to older patients regardless of the excellence of [CVD] care," according to the scientific statement online in .

Ultimately, there are opportunities to enhance cardiac ICU care in this "already dominating and still expanding population of older adults," said the writing group co-chaired by Abdulla Damluji, MD, of Johns Hopkins University in Baltimore, and Daniel Forman, MD, of the University of Pittsburgh Medical Center.

David Morrow, MD, MPH, of Harvard Medical School and Brigham and Women's Hospital in Boston, said he agreed with the statement.

"With the aging of our population, including patients that we care for in the CICU, it is more important than ever that we take approaches to cardiac critical care that are compassionate and patient- and family-focused," he said.

Exactly where improvements can be made is unknown, however, as research is lacking in this area.

"Most clinical trials in acute CVD were performed in younger populations, and the generalizability of these findings to older patients is often confounded by concurrent geriatric syndromes," the authors said.

"Aging itself is a risk factor for cardiovascular pathophysiology that makes older patients vulnerable to acute cardiac illness. Aging is also associated with important changes in organs outside the cardiovascular system, including kidney function, pulmonary reserve, and hemostasis," they said.

The concept of "frailty" is generally said to have a substantial impact during and after cardiac ICU admission -- but is lacking in a validated, unified definition.

"Amid a profusion of frailty literature, many frailty tools are being generated that do not correlate with one another, and it often seems that there is more of a competition than a unifying approach and method. Furthermore, even if frailty was definitively classified and a CICU tool refined, there is no certainty about therapeutic interventions that could substantively improve care," according to Damluji and Forman's group.

Also on their wish list: better discernment of futile interventions that would not help a person's quality of life; and a cardiac ICU risk score comprising frailty, cognition, multimorbidity, and other domains.

For now, there are some promising new approaches to cardiac ICU care for geriatric patients. This includes better transitional care such that people moving from one care setting to another benefit from enhanced provider-patient and provider-provider communications and collaborations, according to the statement.

"Innovative multidisciplinary models of care are being organized that entail collaborative teams from cardiovascular, critical care, and geriatric societies; healthcare systems; and local leadership," the writing group added.

Finally, they said, early critical care mobilization and other preventive cardiac ICU protocols have been shown to improve outcomes in older patients.

"There is a lot that we still have yet to learn to guide best possible holistic practice for patients admitted to the CICU," according to Morrow.

Comment