The death of C. Richard Conti, MD, MACC in February 2022 marked the passing of a global leader in cardiology who played a pivotal role in the history of the American College of Cardiology and the ...College's outreach to the People's Republic of China.
Shared decision‐making is appropriate for clinical decisions involving multiple reasonable options, which occur frequently in the cardiovascular care of older adults. The process includes the ...communication of relevant factual information between the patient and the clinician, elicitation of patient preferences, and a mutual agreement on the best course of action to meet the patient's personal goals. For older adults, there are common challenges and considerations with regard to shared decision‐making, some of which (eg, cognitive impairment) may be biologically linked to cardiovascular disease. There are tools designed to facilitate the shared decision‐making process, known as decision aids, which are broadly effective although have shortcomings when applied to older adults. Novel approaches in clinical research and health systems changes will go some way toward improving shared decision‐making for older adults, but the greatest scope for improvement may be within the grass roots areas of communication skills, interdisciplinary teamwork, and simply asking our patients what matters most.
Abstract 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.
In his book "American Cardiology: The History of a Specialty and Its College," Bruce Fye, MD, MACC, details how, in the period following World War II, factors such as the increasing prevalence of ...heart disease, the advent of federal research funding, breakthroughs in technological innovations, and the growing availability of health insurance worked together to shape cardiology into a major academic and clinical discipline (2). Not to be overlooked, the ACC also established its first National Cardiovascular Data Registry--the CathPCI Registry--to assess the characteristics, treatments, and outcomes of patients with cardiac disease receiving diagnostic catheterization and/or percutaneous coronary intervention procedures.
President's Page: Back to the Future Harold, John Gordon, MD, MACC
Journal of the American College of Cardiology,
03/2014, Letnik:
63, Številka:
8
Journal Article
Recenzirano
Odprti dostop
...CardioSmart also continues to be our cornerstone for patient education. Since the College revamped CardioSmart.org last March, more than 1 million people have visited the website for its ...interactive blood pressure and activity trackers and more than 30 condition centers. The unique online learning environment includes advanced functionality for tracking individual education activities; flexible formats to fit different learning styles; and targeted programming for Fellows in Training, cardiac care team members, and cardiovascular specialty areas.
According to the World Health Organization, the number of deaths from cardiovascular diseases, mainly from heart disease and stroke, is expected to reach 23.3 million by 2030 (1).
...I learned more than I could have dared to hope during my 3-year fellowship and made connections in the cardiovascular field that continue to serve me today. Dr. Swan was my mentor and friend. ...Because of him, I took the stage at the ACC.13 Convocation to accept the presidential chain from Dr. William Zoghbi.
Recognizing the Institute of Medicine's recommendation that the CPG development process be bifurcated into the generation of systematic reviews of the evidence (2), the identification of clinical ...questions, and the proffering of clinical recommendations (3), we are utilizing these processes in our own joint CPGs. ...we feel it is entirely appropriate that the NHLBI has decided to focus its resources and expertise on evaluation of the available research evidence via the systematic review function, while entrusting us with the processes leading to CPG development.
Background:
Patients on hemodialysis (HD) are known to exhibit low values of regional cerebral oxygenation (rSO2) and impaired cognitive functioning. The etiology of both is currently unknown.
...Objective:
To determine the feasibility of serially monitoring rSO2 in patients initiating HD. In addition, we sought to investigate how rSO2 is related to hemodynamic and dialysis parameters.
Design:
Prospective observational study.
Setting:
Single-center tertiary academic teaching hospital in Ontario, Canada.
Participants:
Six patients initiating HD were enrolled in the study.
Methods:
Feasibility was defined as successful study enrollment (>1 patient/month), successful consent rate (>70%), high data capture rates (>90%), and assessment tolerability. Regional cerebral oxygenation monitoring was performed 1 time/wk for the first year of dialysis. A neuropsychological battery was performed 3 times during the study: before dialysis initiation, 3 months, and 1 year after dialysis initiation. The neuropsychological battery included a traditional screening tool: the Repeatable Battery for the Assessment of Neuropsychological Status, and a robot-based assessment: Kinarm.
Results:
Our overall consent rate was 33%, and our enrollment rate was 0.4 patients/mo. In total 243 rSO2 sessions were recorded, with a data capture rate of 91.4% (222/243) across the 6 patients. Throughout the study, no adverse interactions were reported. Correlations between rSO2 with hemodynamic and dialysis parameters showed individual patient variability. However, at the individual level, all patients demonstrated positive correlations between mean arterial pressure and rSO2. Patients who had more than 3 liters of fluid showed significant negative correlations with rSO2. Less cognitive impairment was detected after initiating dialysis.
Limitation:
This small cohort limits conclusions that can be made between rSO2 and hemodynamic and dialysis parameters.
Conclusions:
Prospectively monitoring rSO2 in patients was unfeasible in a single dialysis unit, due to low consent and enrollment rates. However, rSO2 monitoring may provide unique insights into the effects of HD on cerebral oxygenation that should be further investigated.
Trial Registration:
Due to the feasibility nature of this study, no trial registration was performed.
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