Bell Susan P, Orr Nicole M, Dodson John A, Rich Michael W, Wenger Nanette K, Blum Kay, Harold John Gordon, Tinetti Mary E, Maurer Mathew S, Forman Daniel E
Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Center for Quality Aging, Division of Geriatric Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
J Am Coll Cardiol. 2015 Sep 15;66(11):1286-1299. doi: 10.1016/j.jacc.2015.07.048.
The population of older adults is expanding rapidly, and aging predisposes to cardiovascular disease. The principle of patient-centered care must respond to the preponderance of cardiac disease that now occurs in combination with the complexities of old age. Geriatric cardiology melds cardiovascular perspectives with multimorbidity, polypharmacy, frailty, cognitive decline, and other clinical, social, financial, and psychological dimensions of aging. Although some assume that a cardiologist may instinctively cultivate some of these skills over the course of a career, we assert that the volume and complexity of older cardiovascular patients in contemporary practice warrants a more direct approach to achieve suitable training and a more reliable process of care. We present a rationale and vision for geriatric cardiology as a melding of primary cardiovascular and geriatrics skills, thereby infusing cardiology practice with expanded proficiencies in diagnosis, risks, care coordination, communications, end-of-life, and other competences required to best manage older cardiovascular patients.
老年人口正在迅速增长,而衰老会使人易患心血管疾病。以患者为中心的护理原则必须应对当前与老年复杂性并存的大量心脏病问题。老年心脏病学将心血管方面的观点与多种疾病、多种药物治疗、虚弱、认知衰退以及衰老的其他临床、社会、经济和心理层面相结合。尽管有些人认为心脏病专家在职业生涯中可能会本能地培养其中一些技能,但我们认为,当代实践中老年心血管疾病患者的数量和复杂性需要一种更直接的方法来实现适当的培训和更可靠的护理过程。我们提出了将老年心脏病学作为主要心血管技能和老年医学技能融合的基本原理和愿景,从而在心脏病学实践中融入在诊断、风险评估、护理协调、沟通、临终关怀以及最佳管理老年心血管疾病患者所需的其他能力方面更广泛的专业技能。