Dr. Mauricio Cohen Contributes to AHA Statement on Managing Older Adults in Cardiac ICUs

Older adults need special attention when admitted to cardiac intensive care units, according to a new scientific statement from the American Heart Association. “Pre-existing chronic conditions, physical frailty, mental confusion and the use of multiple medications are among the issues caregivers should consider in managing older adults with acute heart conditions,” said Mauricio G. Cohen, M.D., professor of medicine and director of the Cardiac Catheterization Laboratory at the University of Miami Miller School of Medicine.

Dr. Cohen was the senior author of the report, “Older Adults in the Cardiac Intensive Care Unit: Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care: A Scientific Statement From the American Heart Association,” published recently in the journal Circulation.

A former chair of the AHA’s Acute Care Committee, Dr. Cohen was one of 10 distinguished authors of the scientific statement, including Abdulla A. Damluji, M.D., M.P.H., assistant professor of medicine at Johns Hopkins University, director of the Center of Outcomes Research at Inova in Falls Church, Va., and a former Miller School trainee.

“A thoughtful approach to critical care management of older patients with cardiovascular disease is necessary, because they may be more vulnerable than younger patients in the cardiac intensive care unit (CICU),” said Dr. Cohen. “Older patients tend to take longer to recover, and may not be able to regain their prior abilities. In some cases, further treatments may no longer be effective, and physicians will need to discuss these situations with patients and family members.”

Multiple procedures, new medications, sensory overload, sleep deprivation, prolonged bed rest, and malnourishment are usually inherently disruptive to older patients regardless of the excellence of cardiovascular care, added Dr. Cohen.

Key takeaways from the statement include the following:

• Delirium is common in CICUs because of the stress of disease and the destabilizing environment, particularly amid common age-related cognitive changes. New measures and therapies to prevent and treat delirium and related consequences are needed.
• Frail patients with cardiovascular disease may have poor outcomes. Efforts to study prevention and even to reverse frailty should be among the goals of CICU care.
• Multimorbidity is common among older adults and cardiovascular disease-specific strategies of care can inadvertently contribute to existing health problems.
• Adverse events may be linked to detrimental drug-drug and drug-disease interactions, as well as organ dysfunction affecting drug absorption, metabolism, or excretion.
• Immobility, bed rest, acquired muscle weakness, and pressure ulcers are consequences of CICU stay that often exacerbate pre-existing conditions.
• Although optimal caloric intake remains an area of ongoing investigation, enteral nutrition should be considered to prevent mucosal atrophy and to preserve muscle.
• Shared decision-making, end-of-life care, and palliative care services complement care in the CICU. However, palliative care remains significantly underused in the CICU.

“As the nation’s older adult population grows, the influence of these geriatric syndromes on the health care system will be magnified in the years to come,” said Dr. Cohen. “We need to consider these issues and undertake further investigations to integrate the different requirements of older adults into overall CICU models of care.”

Tags: American Heart Association, Dr. Mauricio Cohen, older adults in cardiac ICUs