ACC highlights importance of cognitive impairment, frailty when treating older heart patients

August 14, 2026 - 20:23

The American College of Cardiology has issued a new report that pushes cardiologists to look beyond the heart when treating older adults. The document stresses that cognitive impairment and physical frailty often change how heart disease should be managed, and ignoring these conditions can lead to worse outcomes.

The report outlines five core principles for improving care in this growing patient group. First, every older heart patient should get a quick screening for memory problems and physical weakness, even if they look fine on the surface. Second, treatment plans need to be adjusted based on what the patient can actually tolerate, not just what guidelines say. Third, communication with family members and caregivers is essential, since many older patients struggle to remember instructions or manage complex medication schedules. Fourth, the care team should include geriatric specialists, pharmacists, and social workers, not just cardiologists. Fifth, decisions about procedures like surgery or stents should weigh the patient's overall life expectancy and quality of life, not just the heart's anatomy.

The authors point out that frailty and cognitive decline are common in older heart patients, yet they are often missed in busy clinics. A patient with mild dementia may forget to take blood thinners, while a frail patient may not recover well from an invasive procedure. The report calls for a more holistic approach, where the heart is treated as part of the whole person. It also urges hospitals to create pathways that identify these issues early, so that care plans are realistic and patient-centered.

The ACC hopes this guidance will shift practice, especially as the population ages and heart disease remains the leading cause of death. The full document appears in the Journal of the American College of Cardiology.