The Case for Cardiovascular Centers on Aging

Integrating cardiovascular programs with geriatric services into a new care model — a cardiovascular center on aging — may improve patient care and lead to more efficient use of hospital and clinical resources. Specialized centers of this type would recognize the multiple additional needs of older people and the benefits of a more holistic, patient-centered approach than is possible from more traditional siloed healthcare delivery.

So asserts a team of Cleveland Clinic physicians in a recent “Viewpoint” article in JACC: Advances (2025 Epub 6 Aug). Cleveland Clinic recently launched its own such center, one of the first in the nation.

“Having a heart attack is quite different at age 55 than at age 80,” says first and corresponding author Abdulla Damluji, MD, PhD, an interventional cardiologist and Director of Cleveland Clinic’s Cardiovascular Center on Aging. “You can usually expect a younger patient to resume their previous life after recovery, but that is often not the case with an elderly patient. As people age, they are more likely to be contending with significant comorbidities and other problems of aging, requiring more than focused cardiovascular disease management to achieve good outcomes.”

Dr. Damluji (at right in the photo above) has distinguished himself for his advocacy of improved cardiovascular care for the elderly, serving as chair-elect of the Geriatric Cardiology Leadership Council of the American College of Cardiology. He has authored a series of review articles on the subject, including papers on transcatheter aortic valve replacement (JACC Advances [2024]), acute coronary syndrome (Circulation [2022]) and managing cognitive impairment (J Am Coll Cardiol [2025]) and frailty (J Am Coll Cardiol [2022]).

Why are specialized centers needed?

It is well recognized that the elderly are disproportionately affected by cardiovascular disease, the leading cause of morbidity and mortality in this demographic. What is less appreciated is that management of cardiovascular disease in the elderly goes beyond what’s needed in younger populations. Aging affects cardiovascular clinical presentations, as well as disease progression and treatment response. Reduced social support, polypharmacy, frailty, cognitive impairment and functional decline contribute to the complexity of cardiovascular management in the elderly.

“Not surprisingly, cardiovascular specialists are most comfortable managing cardiovascular problems,” Dr. Damluji notes. “It makes sense to bring in geriatricians proactively, with the goal of optimizing outcomes.”

“The aging of the population presents unique challenges in the delivery of optimal care,” says Venu Menon, MD, a co-author of the new JACC: Advances paper and Section Head of Clinical Cardiology at Cleveland Clinic. “Efforts like our Cardiovascular Center on Aging will help us optimize prevention, maintenance and functional recovery from cardiovascular disease in all its forms.”

Another important role of a cardiovascular center on aging is to provide data on cardiovascular interventions and medications for this group of patients.

“Elderly cardiovascular patients, especially those with comorbidities, are often most in need of new therapeutic options but are frequently excluded from clinical trials,” Dr. Damluji points out. “We are often acting without evidence for these patients.”

The Cleveland Clinic model

Incorporating the services of Cleveland Clinic’s Center for Geriatric Medicine, Drs. Damluji and Menon spearheaded Cleveland Clinic’s Cardiovascular Center on Aging, which is housed in its Heart, Vascular and Thoracic Institute. To support the center’s cardiovascular services, it is also staffed by four geriatricians, three geriatric pharmacists and an advanced practice provider. The Center is also recruiting a cardiologist certified in geriatrics and will soon incorporate cardiovascular fellows into the program.

“Our goal is to provide comprehensive, multidisciplinary care to elderly patients at highest risk,” says another co-author of the JACC: Advances paper, Ardeshir Hashmi, MD, Section Chief of the Center for Geriatric Medicine, who oversees geriatric services for the Cardiovascular Center on Aging.

The center provides geriatric services to cardiovascular inpatients older than 75 years with at least one risk factor, such as hyperpolypharmacy (> 10 prescription medications), severe frailty, cognitive impairment, multiple hospitalizations or emergency visits in the previous six months, advanced heart failure, weight loss or limited social support.

Dr. Hashmi (at left in photo above) explains that identified at-risk inpatients are rounded on daily by a team that includes a cardiovascular specialist, a geriatrician and a pharmacist. Geriatric consults focus on “four M’s”: mentation, mobility, medications and what matters most to the patient. The program will soon expand to include high-risk patients undergoing elective outpatient interventions.

“We carefully consider factors beyond standard guidelines,” Dr. Hashmi adds, “such as ‘Is the patient likely to cognitively be able to follow complex treatment recommendations?’” He notes that Cleveland Clinic is a participating site of Patient Priorities Care, an approach focused on the elderly to identify patient priorities and ensure that management is aligned with each individual’s goals.

“Our Cardiovascular Center on Aging not only identifies and manages the unique needs of cardiac patients across different age groups but also helps implement measures to influence cardiac aging positively,” observes Samir Kapadia, MD, Chair of Cardiovascular Medicine at Cleveland Clinic. “I’m excited that we were able to recruit Dr. Damluji to lead this effort.”

Promising studies underway

Other important roles of the Cardiovascular Center on Aging are to collect data for clinical and translational research and to provide education and training for healthcare providers.

Dr. Damluji is keeping an eye on clinical trials focused on improving healthcare of elderly cardiovascular patients. Two of interest that are underway are:

• LIVEBETTER (NCT05786417), evaluating the use of standard anti-anginal medications in patients at least 70 years old with stable angina and multiple comorbidities. This phase 4 clinical trial is scheduled for completion in mid-2027.
• REHAB-HFpEF (NCT05525663), evaluating the use of a novel rehabilitation intervention in patients at least 60 years old. Trial completion is expected in early 2028.

“With the burgeoning interest in this topic as our population ages, I look forward to many more clinical trials focused on cardiovascular care for older patients,” Dr. Damluji says.

Tips for starting a cardiovascular center on aging

Drs. Damluji, Hashmi and Menon encourage other medical facilities to adopt something similar to their team’s model of combining geriatric and cardiovascular services for high-risk elderly patients. They recommend helpful resources that can assist institutions with developing such a center:

• The Institute for Healthcare Improvement (IHI), which supports a variety of quality initiatives; Cleveland Clinic’s Center for Geriatric Medicine has earned IHI recognition as an “Age-Friendly Health System – Committed to Care Excellence” program
• The John A. Hartford Foundation, which specializes in improving healthcare for elderly patients
• Essentials of Cardiovascular Care for Older Adults, a comprehensive online curriculum developed by the American College of Cardiology

Dr. Damluji also emphasizes important factors needed for a successful program, including institutional support, optimal staffing, and infrastructure for collecting and storing data in meaningful ways to enhance clinical care and conduct research.

Dr. Hashmi adds that it’s critical that all members of the team — cardiovascular physicians, geriatricians and pharmacists — foster a culture of collaboration and mutual respect.