Calling for a New Subspecialty in Geriatric Cardiology
To the Editor: Our population is aging. There are about 36 million persons who are 65 years or older in the United States today, and this number is expected to double by the year 2030.¹ 

The epidemic of cardiovascular diseases has had a major impact on older age-groups. These diseases are very common and result in high mortality and morbidity rates. Obviously, the economic burden on the healthcare system is significant. As the population ages, an increased number of elderly people will develop cardiovascular disease, with its consequences.

Geriatric medicine aims to comprehensively focus on the biological, psychological, and social factors involved in the aging process. There is no doubt that cardiology contributed significantly to this demographic transition. Cardiology is a curative specialty for acute conditions that has attained outstanding results in decreasing mortality with the advanced technological resources available today. However, this field focuses on the disease rather than on the patient.

Therefore, a potential conflict exists: cardiology is a specialty prone to prioritizing the disease and not the patient, the acute rather than the chronic. Yet this specialty has increasingly had to treat patients of older age-groups who have multiple chronic and complex diseases. Elderly patients are subjected to different social and environmental influences, as well as to disease, polypharmacy, and iatrogeny. They are a heterogeneous group of patients that cannot be adequately included in the guidelines established to standardize medical procedures. Elderly patients need individualized treatment that takes into consideration the wishes of the patient and his or her family.

Geriatric cardiology will provide an intersection between cardiology and geriatrics, in an attempt to solve this conflict. Its main objective will be to improve cardiac care for elderly patients.

Multidisciplinary teamwork, which has been the approach of geriatrics for many years, needs to be implemented into cardiology. The study of comorbidities and their consequences in elderly cardiac patients merits greater attention. Cardiovascular health is essential but is only one facet of older patient well-being.

In recent years geriatric cardiology has gradually been incorporated into the medical culture. As a consequence, the Geriatric Cardiology Society was created.

This demographic transition requires that all physicians, including cardiologists, become more familiar with “geriatric culture.” Interest in geriatric cardiology has been mostly outside of the United States. It’s time that we recognize the need for a new subspecialty in cardiology in this country.

The need to provide qualified care for older patients is a task much more challenging than the management of younger patients. Therefore, geriatric cardiology must be considered a subspecialty. To improve the care of our older patients, we need to emphasize improving the original disciplines and suggest new practices. The reality we face in our own practice at Baylor College of Medicine  clearly shows that geriatric cardiology is an essential requirement nowadays and will become increasingly more so in the future.

J. Roberto Duran III, MD
George Taffet, MD
Department of Medicine
Division of Geriatrics
Baylor College of Medicine
Houston, Tex

1. He W, Sengupta M, Velkoff V, et al, for the US Census Bureau. Current Population Reports. 65+ in the United States: 2005. Washington, DC: US Government Printing Office; 2005. Publication #P23-209.