ABC | Volume 114, Nº3, March 2020

Viewpoint The Evolving Landscape of the Geriatric Cardiology Field in Brazil: New Challenges for a New World Caio de Assis Moura Tavares, 1 A ndré Feitosa Wanderley Cavalcanti, 1 Wilson Jacob Filho 1 Unidade de Cardiogeriatria - Instituto do Coração (InCor) - Hospital das Clínicas HCFMUSP - Faculdade de Medicina - Universidade de São Paulo, 1 São Paulo, SP – Brazil “Do we practice Geriatric Cardiology?”. It was with this editorial, published in the Journal of the American College of Cardiology (JACC), 1 in 1997, that Dr. William W. Parmley highlighted the need to develop specialized care for the geriatric population worldwide. Two decades later, it is considered by some as the starting point for the growth of Geriatric Cardiology in America. Even though the Society of Geriatric Cardiology was founded in 1986, it was not bonded to either the American College of Cardiology or the American Heart Association, and it lacked major impact in the field. With the global phenomenon of aging, cardiologists were involved in the care of elderly patients more frequently, thus initiatives were developed to fulfill their needs. For instance, in 2007, an online curriculum of continuing medical education (CME) was developed by the ACC/SGC and provided for its members, as well as published in a new editorial in the JACC. 2 In 2011, the SGCwas extinguished and added to the Geriatric Cardiology chapter of the ACC. By that time, the world had already recognized the inevitability of population aging and had already realized the importance of both giving professionals a super specialized competence (specialization in this age group) and of providing the potentially aging population with the possibility of having their demands answered by taking into account their individual characteristics, rather than the conditions they suffered from. In Brazil, under Prof. Dr. Luís Gastão Costa Carvalho do Serro Azul’s pioneering leadership, the Heart Institute (InCor) Cardio Geriatric Clinical Unit was founded in 1982 (4 years before the foundation of the American Society of Geriatric Cardiology), a movement that placed our country at the forefront of this issue. In the 90s, Geriatric Cardiology was recognized by the Brazilian Cardiology Society, initially as a study group in Cardiogeriatrics (GEBRAC) and, since 2005, as a department (DECAGE). In 2006 and 2014, two articles were published which reinforced the importance of Geriatric Cardiology among the Brazilian medical society. The first article, by Prof Dr. Maurício Wajngarten, 3 listed the challenges ahead and the need for preparing for the elderly population care. The second article, by Prof Roberto Franken and Dr. Ronaldo Fernandes Rosa, 4 highlighted the contribution of the DECAGE for the education and training in Geriatric Cardiology, by means of a partnership with the ACC, as well as the advances in scientific evidence generated by the department. In addition, it listed essential abilities for full care of the elderly. Due to those needs, the Brazilian Cardiology Society published specific Geriatric Cardiology guidelines: the first, in 2002, 5 and the second, in 2010, 6 which was updated in 2019. 7 The necessary contents of training professionals for due care of cardiovascular disease in elderly patients were also listed in the 1st Guidelines on Processes and Competences for Cardiology Training in Brazil. 8 The essence of geriatric cardiology Because it is a recent and not widespread specialty, Geriatric Cardiology is often confused with Geriatrics that is practiced by a cardiologist or simply with Cardiology that is applied to elderly patients. Although this is part of the discipline’s core, it does not represent the whole picture. It would be more adequate to define it as integrated and age- adequate cardiovascular care, centered on the patients 9 and their functionalities – a concept previously presented by our colleagues 3,4 - that has been evolving and taking shape, as a result of the use of specific and predetermined tools. Objectively, one could consider it as cardiology practice integrated with the Geriatric’s 5 Ms: medication (focusing on prescribing the absolutely necessary, targeting at reducing polypharmacy, minimizing interactions and adverse reactions; following Beers criteria to select appropriate medication for the elderly), mentation (vigilance, prevention and treatment of cognitive disturbances), mobility (valuing and implementing strategies that seek to maintain the patient’s mechanical functionality), multimorbidity (approaching the patient not only by looking up the cardiovascular system, but also by considering the occurrence of multiple comorbidities to be the rule, not the exception, in these individuals), and last, but literally not least is matters most (always consider the patient’s opinion regarding the benefits and burdens of the treatment, taking into account the biography and personal values, bringing the patient into the center of decision making). We would also add a sixth and last M, multidisciplinary, for the care of the elderly, remembering it must be coordinated in a horizontal fashion by a professional, but never concentrated in only one person, giving due importance to the participation of other specialists and healthcare professionals. At our institute, in the Geriatric Cardiology Unit, we perform in all patients Mailling Address: Caio de Assis Moura Tavares • Unidade de Cardiogeriatria do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 44, 2º andar, sala 06. Postal Code 05403-900, São Paulo, SP – Brazi E-mail: caio.tavares@usp.br Manuscript received May 20, 2019, revised manuscript August 20, 2019, accepted September 10, 2019 DOI: https://doi.org/10.36660/abc.20190292 Keywords Geriatrics/trends; Geriatric Assessment; Population Dynamics; Cardiology/trends; Aged; Delivery of Health Care; Frail Elderly; Health Services for the Aged. 571