Intended for healthcare professionals

Clinical Review State of the Art Review

Cardiovascular care of older adults

BMJ 2021; 374 doi: (Published 31 August 2021) Cite this as: BMJ 2021;374:n1593
  1. Deirdre E O’Neill, assistant professor of medicine1,
  2. Daniel E Forman, professor of medicine2
  1. 1University of Alberta Hospital, Edmonton, AB, Canada
  2. 2University of Pittsburgh, University of Pittsburgh Medical Center and VA Pittsburgh Geriatric, Research, Education and Clinical Center (GRECC), Pittsburgh, PA, USA
  1. Correspondence to: D E Forman formand{at}


Age is an independent risk factor for cardiovascular disease. With the accelerated growth of the population of older adults, geriatric and cardiac care are becoming increasingly entwined. Although cardiovascular disease in younger adults often occurs as an isolated problem, it is more likely to occur in combination with clinical challenges related to age in older patients. Management of cardiovascular disease is transmuted by the context of multimorbidity, frailty, polypharmacy, cognitive dysfunction, functional decline, and other complexities of age. This means that additional insight and skills are needed to manage a broader range of relevant problems in older patients with cardiovascular disease. This review covers geriatric conditions that are relevant when treating older adults with cardiovascular disease, particularly management considerations. Traditional practice guidelines are generally well suited for robust older adults, but many others benefit from a relatively more personalized therapeutic approach that allows for a range of medical circumstances and idiosyncratic goals of care. This requires weighing of risks and benefits amidst the patient’s aggregate clinical status and the ability to communicate effectively about this with patients and, where appropriate, their care givers in a process of shared decision making. Such a personalized approach can be particularly gratifying, as it provides opportunities to optimize an older patient’s function and quality of life at a time in life when these often become foremost therapeutic priorities.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors: DEO and DEF have joint authorship on this paper. DEO did the research and wrote all drafts and the final version of the paper. DEF added substantial contributions to the conception of the paper, revised all drafts, and provided additional content to the paper throughout the revision process.

  • Funding: DEF receives funds from the National Institute of Aging through grants R01AG060499, R01AG058883, and P30AG024827.

  • Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: none.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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