Scientific statement reframes cardiovascular care for older patients with cognitive impairment and frailty

Older adults with cardiovascular disease (CVD) often have coexisting cognitive impairment and frailty, conditions that can significantly affect treatment decisions, recovery, independence and quality of life and should be considered as part of an aging-informed approach to care, according to a new American College of Cardiology Scientific Statement published in JACC, the flagship journal of the ACC.

An estimated one-third of patients seen in cardiology clinics have some degree of cognitive impairment, while frailty affects approximately one-half of community-dwelling older adults and two-thirds of older adults undergoing percutaneous coronary intervention.

The statement reviews the interconnected relationship between cardiovascular disease, cognitive impairment and frailty and outlines practical, consensus-based strategies for prevention, screening, assessment and management.

This statement reframes cardiovascular care for older adults beyond a traditional disease-centered model to a more aging-informed, function-centered approach. For many older adults, the most important outcomes are not prevention of cardiovascular events, but maintaining cognitive health, physical function, and independence."

Karen P. Alexander, MD, FACC, chair of the scientific statement's writing committee and professor of medicine, Duke University School of Medicine

According to the statement, cardiovascular disease, cognitive impairment and frailty share many risk factors and underlying biological mechanisms, including vascular dysfunction, chronic inflammation and age-related declines in physiological reserve. The authors note that these conditions frequently coexist and can influence treatment tolerance, medication adherence, recovery from cardiovascular procedures and the ability to maintain independence.

Key recommendations for clinicians:

• Consider cardiovascular disease in the context of biological aging rather than chronological age alone.
• Address shared modifiable risk factors and social and environmental health drivers.
• Implement screening for cognitive impairment and frailty in outpatient settings and following hospitalization if feasible.
• Pursue diagnostic evaluation and timely referral when impairment is suspected.
• Promote resilience through multicomponent interventions, including cardiac rehabilitation, multidomain exercise, nutritional optimization and thoughtful medication management to reduce polypharmacy-related harms.

The statement also highlights evidence gaps and calls for greater inclusion of older adults in cardiovascular research, emphasizing the need for studies that measure outcomes most meaningful to patients, including independence, mobility, cognitive function and caregiver burden.