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Cardiovascular Disease in the Elderly: Cardiogeriatric Assessment, Prevention, Treatment Outcomes and Perspectives

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 20 December 2026 | Viewed by 2310

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Editor

Dr. Georgia Vamvakou

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Guest Editor

Department of Cardiology & 65+ Geriatric Outpatient Clinic, Amalia Fleming General Hospital, 14, 25th Martiou Str., 15127 Melissia, Greece
Interests: geriatric cardiology; cardiovascular rehabilitation; aging research; personalized medicine

Special Issue Information

Dear Colleagues,

This Special Issue will focus on cardiovascular disease in the elderly: cardiogeriatric assessment, prevention, treatment, outcomes, and perspectives.

The issue aims to integrate the latest insights from epidemiological data, frailty scores, preinterventional assessment, clinical characteristics of cardiovascular disease in the elderly, treatment plans, and outcomes, as well as perspectives concerning public health and the role of the digital era in addressing diagnosis and therapeutic planning.

Topics covered will include the following:

Cardiogeriatric assessment regarding frailty, fall risk scores, sarcopenia, and obesity in the elderly at the clinical level. Preinterventional assessment before cardiac surgery or other cardiovascular intervention and outcomes.
Epidemiological data on cardiovascular disease trends in the elderly population at the national or global level. Perspectives concerning public health.
Primary and secondary prevention strategies. Clinical characteristics of cardiovascular disease in the elderly. Therapeutic goals, postinterventional cardiogeriatric rehabilitation, cardiovascular rehabilitation planning, and outcomes.
The role of digital medicine in the diagnosis and treatment of the elderly and its impact on quality of life.
Submissions are expected to include original research articles and review papers that advance our understanding of the role of cardiovascular disease in the elderly.

Contributions that highlight new insights on cardiovascular disease in the elderly and present therapeutic strategies for promoting healthy aging are especially welcome.

Dr. Georgia Vamvakou
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cardiovascular diseases
elderly patients
cardiogeriatric assessment
diagnosis and therapeutic planning
healthy aging
digital medicine

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Published Papers (4 papers)

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Research

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11 pages, 380 KB

Open AccessArticle

Frailty and Echocardiographic Indices of Diastolic Function in Older Adults: A Cross-Sectional Analysis

by Dimitrios Anagnostou, Georgia Vamvakou, Zoi Kollia, Christos Chitas, Nikolaos Theodorakis, Sofia Kalantzi, Aikaterini Spyridaki, Vassilis Milionis, Michalitsa Christodoulou, Ioanna Nella, Efi Gourzoulidou, Sofia Athinaiou, Gesthimani Triantafylli and Maria Nikolaou

J. Clin. Med. 2026, 15(12), 4645; https://doi.org/10.3390/jcm15124645 - 15 Jun 2026

Viewed by 317

Abstract

Background: Frailty in older adults is linked to adverse cardiovascular outcomes, but its relationship with echocardiographic markers of diastolic function remains unclear. We examined associations between frailty measures and indices of diastolic function in community-dwelling older adults. Methods: This cross-sectional study included 537 adults aged ≥65 years from a multidisciplinary outpatient clinic. Frailty was assessed using the Fried phenotype, Clinical Frailty Scale (CFS), gait speed, and handgrip strength. Associations with diastolic indices were analyzed using multivariable regression with sequential adjustment. Sensitivity analysis was performed via matching. Results: According to the Fried phenotype, 30.8% of participants were robust, 59.7% pre-frail, and 9.5% frail. Indexed left atrial dimension (LAi) was consistently higher in frail individuals. Frailty was also associated with higher odds of elevated right ventricular systolic pressure (>35 mmHg) in unadjusted analyses. Using the CFS, individuals with a score higher than 3 had significantly higher NT-proBNP levels compared to those with a score of 1–2. Higher gait speed and handgrip strength were associated with more favorable cardiac structure, including smaller left heart chamber sizes, and lower natriuretic peptide levels. Conclusions: Frailty was independently associated with structural and functional markers of diastolic dysfunction in older adults, particularly left atrial enlargement (as captured in Fried) and NT-proBNP elevation (as captured in CFS), supporting the integration of frailty assessment into cardiovascular risk evaluation. Full article

(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Cardiogeriatric Assessment, Prevention, Treatment Outcomes and Perspectives)

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14 pages, 479 KB

Open AccessArticle

Heart Failure in Older Adults: Real-World Outcomes and Patient Profiles by Admission Service and Sex

by Clara Bonanad, Claudio Rivadulla, Francisca Esteve-Claramunt, Daznia Bompart, Guillermo Barreres, Carles Muñoz-Alfonso, Daniela Maidana, Enrique Rodriguez-Borja, Gema Torres, Georgiana Zaharia and Sergio Garcia-Blas

J. Clin. Med. 2026, 15(11), 4062; https://doi.org/10.3390/jcm15114062 - 24 May 2026

Viewed by 415

Abstract

Objectives: This study aims to describe real-world clinical profiles, treatment patterns and one-year outcomes of older adults hospitalized for acute heart failure (HF) across different admission services, and to examine whether sex influences these characteristics and outcomes. Methods: We performed a retrospective study including 1226 patients aged ≥80 years hospitalized for acute HF between 2018 and 2021. Patients were categorized by admitting service (cardiology [CAR] or internal medicine [IM]) and sex. The primary endpoint was all-cause mortality at 12 months, with secondary endpoints including HF readmission and a composite of death or HF readmission. Results: The mean age was 87.4 ± 4.4 years, 65.8% were women, and 80% presented HF with preserved ejection fraction (HFpEF). Admission services reflected differing patient profiles: individuals admitted under IM were older, predominantly female, and more frequently presented with HFpEF and worse functional class, while CAR admissions included a higher proportion of patients with ischemic disease. Use of guideline-directed medical therapy varied according to clinical characteristics and admitting service. At 12 months, mortality and the composite endpoint differed across admission services, whereas HF readmission rates were similar. Sex-stratified analyses showed no difference in all-cause mortality or in the composite endpoint, but women experienced more frequent HF readmissions. Conclusions: Among very old adults hospitalized for acute HF, clinical profiles, therapeutic patterns, and outcomes differ according to patient characteristics and hospital admission pathways. Sex also shapes clinical presentation and readmission patterns. These findings highlight the importance of harmonized, multidisciplinary, and sex-sensitive HF care pathways to address the diverse needs of an aging HF population. Full article

(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Cardiogeriatric Assessment, Prevention, Treatment Outcomes and Perspectives)

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15 pages, 815 KB

Open AccessArticle

Cardiac Syncope: An Underestimated Cause of Unexplained Syncope in the Elderly-Data from a Single High-Volume Syncope Unit

by Stefanos Archontakis, Evangelos Oikonomou, Nikias Milaras, Panagiotis Dourvas, Tzonatan Klogkeri, Dimitrios Kalantzis, Anastasios Markakos, Michail Ampeliotis, Artemis Papadima, Dimitrios Venetsanos, Sotirios Tsalamandris, Dimitrios Syrseloudis and Skevos Sideris

J. Clin. Med. 2026, 15(6), 2450; https://doi.org/10.3390/jcm15062450 - 23 Mar 2026

Viewed by 1090

Abstract

Background/Objectives: Syncope remains a common problem in the elderly, adversely affecting quality of life, morbidity and mortality. Diagnosis is challenging due to the atypical presentation, multifactorial aetiology, overlap with non-syncoptic falls and increased prevalence of cardiac disease. This study aims to investigate the impact of cardiac syncope in this high-risk population. Methods: A retrospective single-centre observational cohort study, including 171 patients ≥65 years old with syncope of unknown origin or other falls, was conducted. Different diagnostic tests and strategies were utilised during the investigational process, based on clinical judgement and the latest guidelines. Patients were classified either in the ‘high risk’ (‘cardiac’) or ‘low-risk’ (‘autonomic’) pathway. Results: Mean age was 76.4 ± 6.6 years (range: 65–92 years old) and the mean follow-up period was 40.5 months. Our study population was characterised by a high incidence of comorbidities and underlying heart disease, and polypharmacy. One third of the patients did not report prodromals, 81.9% had no recognisable trigger and 43.3% had various 12-lead ECG abnormalities. Overall, 67.8% of the patients were stratified in the ‘cardiac pathway’. Eventually, a final diagnosis was established in 126 patients (73.7%). The cause was cardiac syncope in 56.4%, reflex syncope in 26.2%, orthostatic hypotension in 7.9% and non-syncopal falls in 9.5%. An ILR was implanted in 90.1% with a diagnostic yield of 43%. ECG-based diagnosis occurred in 53.2% whereas time to diagnosis was 4.8 ± 3.3 months. Conclusions: Cardiac disease, mostly arrythmias, represent a common and possibly underestimated cause of unexplained syncope in the elderly. A structured approach including a targeted use of ILRs improves investigational process. Full article

(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Cardiogeriatric Assessment, Prevention, Treatment Outcomes and Perspectives)

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Review

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16 pages, 1398 KB

Open AccessReview

Management of Syncope in Geriatric Patients: Are 2018 European Society of Cardiology Guidelines Still Relevant?

by Barbara Antonazzo, Anna Sirignano, Martina Salvini, Francesca Flavia Rossi, Stefano Ronzoni, Agnese Dorizzi, Kenneth Ellenbogen, Giuseppe Biondi-Zoccai and Simone Calcagno

J. Clin. Med. 2026, 15(16), 6303; https://doi.org/10.3390/jcm15166303 - 14 Aug 2026

Abstract

Syncope in older adults is common, heterogeneous, and frequently misclassified as an unexplained fall, leading to injury, fear of recurrence, and costly, low-yield testing and hospitalization. The 2018 European Society of Cardiology (ESC) Guidelines emphasize structured initial evaluation (history with witnesses, orthostatic blood pressure, and 12-lead ECG), risk-feature-guided disposition, and targeted second-line investigations rather than routine neuroimaging or carotid duplex ultrasound. We performed a structured narrative review anchored to the ESC 2018 Guidelines, searching MEDLINE/PubMed up to February 2026 for randomized trials, observational cohorts, and systematic reviews with substantial representation of adults aged ≥65 years and extracting geriatric-relevant outcomes including injury, falls, admission, arrhythmic diagnoses, and short-term serious events. Evidence since 2018 supports the enduring value of the ESC 2018 Guidelines’ framework but highlights the need for geriatric adaptation: repeated orthostatic phenotyping (including post-prandial and delayed hypotension), systematic deprescribing, and explicit integration of frailty, cognition, and trauma risk into disposition decisions. Post-2018 data strengthen mechanism-based strategies, including earlier implantable loop recorders with remote monitoring and selective pacing for tilt-induced asystolic reflex syncope, while cardioneuroablation remains investigational for most elders. We propose a pragmatic pathway prioritizing diagnostic yield, minimizing low-value testing, and aligning interventions with patient goals and functional outcomes to reduce recurrences and support safer transitions. Full article

(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Cardiogeriatric Assessment, Prevention, Treatment Outcomes and Perspectives)

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