Who Should Be the Cardiogeriatrician? A Competency-Based Perspective for an Ageing Cardiovascular Population

Figures

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  Figure 1. From disease-centred to competency-based cardiovascular care in older adults. Legends: Traditional cardiovascular care is primarily organised around disease severity, guideline-driven thresholds, and organ-centred endpoints. In very old adults, this approach may insufficiently capture the impact of frailty, functional reserve, multimorbidity, and vulnerability to harm. A competency-based cardiogeriatric model shifts clinical reasoning toward proportionality of care, trajectory-based interpretation, and goal-concordant decision-making, integrating cardiovascular expertise with geriatric principles to optimise meaningful functional outcomes beyond disease-specific endpoints.

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  Figure 2. Decision-making continuum according to clinical stability and complexity. Legend: This figure illustrates a continuous decision-making spectrum in the care of older adults with cardiovascular disease, organised according to increasing clinical complexity and uncertainty. In stable or standard situations, cardiogeriatric autonomy allows independent management based on defined competencies. Situations of intermediate uncertainty require shared discussion between cardiology and geriatrics. In highly complex cases or when invasive decisions are considered, cardiology-led expertise becomes essential. This continuum highlights a non-normative, escalation-based approach in which cardiogeriatric autonomy applies in standard situations, while cardiology expertise remains crucial as complexity increases.

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  Figure 3. A competency-based framework for cardiogeriatric practice within collaborative cardiovascular care. Legend: Conceptual representation of a competency-based framework for cardiogeriatric practice within collaborative cardiovascular care. Core cardiogeriatric competencies include frailty and functional assessment, proportionality of care, goal-concordant decision-making, and standard cardiovascular management in clinically stable situations. Focused bedside echocardiography is shown as a decision-support tool and does not replace comprehensive cardiology-led imaging. The framework highlights complementary geriatric and cardiology expertise, with bidirectional interactions based on consultation, confirmation, escalation, and shared decision-making. The figure is conceptual and intended for hypothesis generation and evaluation, not as a validated decision tool.