1064 Age and Ageing 2021; 50: 1064–1068 https://doi.org/10.1093/ageing/afab057 Published electronically 9 April 2021 © The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions,please email: journals.permissions@oup.com NEW HORIZONS New horizons in cardiogeriatrics: geriatricians and heart failure care—the custard in the tart, not the icing on the cake Shuli Levy 1,2 , Graham Cole 1 , Punam Pabari 1 , Melanie Dani 2 , Carys Barton 1 , Jamil Mayet 1 , Theresa McDonagh 3 , John Baxter 4 , Carla Plymen 1 1 Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK 2 Department of Medicine for the Elderly, Imperial College Healthcare NHS Trust, London, UK 3 Department of Cardiology, Kings College Hospital NHS Foundation Trust, London, UK 4 Department of Medicine for the Elderly, Sunderland Royal Hospital, Sunderland, UK Address correspondence to: Shuli Levy. Email: shuli.levy@nhs.net Abstract Heart failure (HF) can be considered a disease of older people. It is a leading cause of hospitalisation and is associated with high rates of morbidity and mortality in the over-65s. In 2012, an editorial in this journal detailed the latest HF research and guidelines, calling for greater integration of geriatricians in HF care. Tis current article reflects upon what has been achieved in this field in recent years, highlighting some future challenges and promising areas. It is written from the perspective of one such integrated team and explores the new role of cardiogeriatrician, working in a multidisciplinary team to deliver and improve care to increasingly complex, older, frail patients with multiple comorbidities who present with primary cardiology problems, especially decompensated HF. Geriatric liaison has improved the care of frail patients in orthopaedics, cancer services, stroke, acute medicine and numerous community settings. We propose that this vital role should now be extended to cardiology teams in general and to HF in particular. Keywords: heart failure, cardiogeriatrics, older people, multimorbid, frail Key Points • Geriatric syndromes such as polypharmacy, frailty, dementia and depression are extremely common in the HF population. • Te HF population is increasingly co-morbid and integrated geriatrician care is key to holistic management. • Te integration of a cardiogeriatrician into the HF MDT benefits patients and mutually educates and develops teams. • Tere is increasing evidence for a number of novel therapies in HF in older people, with other areas needing further research. Heart failure (HF) affects nearly a million people in the UK and is increasingly prevalent [1]. Incidence increases with age and though the average age at first admission to hospital in the UK is 78 years [2], decompensated HF remains the biggest cause of emergency admissions in the over-65s [3]. HF is not a benign diagnosis, incurring a 50% five-year mortality—worse than many cancers [4]; in those aged over 80 years, this is significantly higher [5]. Tis ensures that caring for patients with HF forms a large part of a geria- tricians’ workload. Tis article will explore the HF landscape from a Geriatrician’s perspective, with particular emphasis on opportunities for collaborative working and sub-speciality development. Therapeutic advances and opportunities Medical therapy is the mainstay of treatment for HF with reduced ejection fraction (HFrEF) [6], improving morbidity and mortality by up to 50% and potentially trebling survival time [7]. Whilst UK national audit data has shown an overall improvement in the prescription of disease modifying medi- cations for inpatients overall, there is differential prescribing in older age groups, with a progressive reduction for each additional decade above the 55–64 year age bracket [2]. For example, over 80% of those aged 55–64 years receive an ACE inhibitor; dropping to less than 65% in those over 85 years. Similarly, older people are less likely to be managed Downloaded from https://academic.oup.com/ageing/article/50/4/1064/6218822 by guest on 29 April 2023