Love Thy Neighbor, Love Thy Patient
February marks American Heart Month, but whether we think about the heart this month because it coincides with our celebration of Valentine’s Day or for some other reason, it is important to remember that an estimated 82.6 million American adults have one or more cardiovascular diseases (CVD). If one includes hypertension, approximately half of affected adults are older than 60 years, and 33% of CVD deaths occur before the age of 75 years.
The average annual rate of a first cardiovascular event rises from three per 1000 men between the ages of 34 and 44 years to 74 per 1000 men between the ages of 85 and 94 years. Approximately 72% of those aged 60 to 79 years and more than 80% of those older than 80 years have CVD.
The average patient age at a first myocardial infarction is 64.5 years for men and 70.3 years for women. Approximately 16% of men and 27% of women aged 55 to 64 years have blood cholesterol levels of 240 mg/dL or higher. Similar levels of total blood cholesterol are observed in 7.9% and 21.8% of men and women, respectively, aged 65 to 74 years, and 8.6% and 19.4% of men and women, respectively, aged 75 years and older.
In brief, the annual cost of treating CVD for adults older than 65 years exceeds $100 billion, accounting for approximately 37% of the total cost of CVD. Obesity and diabetes mellitus are on the rise, both contributing significantly to the risk of developing CVD. While advancements in treating CVD have improved quality of life and reduced mortality, prevention is key! Lifetime attention to maintaining a healthy weight, blood pressure, and lipid levels is essential, and finding ways to reduce stress in one’s life may also have a positive effect on reducing CVD. I would encourage you to visit the American Heart Association’s Website at www.heart.org for resources that you can share with your patients in your conversations about leading a heart-healthy life.
With these facts in mind, I thought it would be a good opportunity to review the importance of advance directives in this month’s issue of Clinical Geriatrics®. Advance directives are vital to providing appropriate and desired care to patients at the end of life, yet many physicians do not work with patients and their families to complete this paperwork, and many families fail to have end-of-life conversations with their loved ones because of the difficult and saddening nature of such discussions. However, an advance directive is not only advised for terminally ill patients. Healthy older adults and those with well-managed comorbidities should consider preparing an advance directive while they still have decision-making power and capacity. Preparedness cannot be undervalued in the goal of ensuring that patients receive dignified care in line with their wishes in the face of terminal illness or in an emergency situation.
Whether it is American Heart Month or not, physicians should be proactive throughout the year in discussing preventive measures, such as lifestyle modifications and advance directives, to ensure optimal health and well-being of their patients into old age. Physicians can also play an instrumental role in encouraging families and caregivers to do the same for their loved ones.