In 2010, the first of the “baby boomers” turned 65 years old. We have now entered a period of explosive growth in the older adult population
in the USA, from just over 40 million in 2010 to approximately 73 million by 2030, an increase of over 80%.1 Concomitantly, the proportion of the populace over age 65 will increase from about 1 in 8 to about 1 in 5. Similar demographic shifts are occurring in many countries around the world. Accompanying this “graying” of the population, there will be a dramatic rise in the number of older persons with clinically manifest—or at risk for developing—cardiovascular disorders, including hypertension, coronary artery disease, valvular heart disease, heart failure, and cardiac rhythm disturbances. Since persons over age 65 already account for more than 80% of all deaths attributable to cardiovascular disease, it will become imperative in the years ahead for all clinicians involved in the care of older adults—not just primary care physicians, geriatricians, and cardiologists, but also surgeons, anesthesiologists, other medical subspecialists, and nurse practitioners—to have a basic understanding of the effects of aging on cardiovascular structure and function, as well as of the impact of aging and prevalent comorbid conditions on the clinical presentation, diagnosis, and response to therapy in older adults with cardiovascular disease. As with prior editions, the primary objective of the present volume is to provide an up-to-date and in-depth, yet clinically relevant and “readable” overview of the epidemiology, pathophysiology, evaluation, and treatment of cardiovascular disorders in older adults. All chapters have been thoroughly updated by recognized experts to incorporate the most recent knowledge in the field.
To the extent possible, clinical recommendations are “ evidence based,” but it is also acknowledged that existing data are often very limited or nonexistent in the very elderly (persons 85 years of age or older), and especially in older adults with multiple coexisting conditions and/or frailty. Thus, careful consideration of each patient’s unique clinical and psychosocial circumstances, medical and nonmedical needs, and personal preferences is required in designing an individualized care plan. Indeed, it is perhaps in the compassionate management of these challenging patients where the “art of medicine” most clearly flourishes.