ABSTRACT
SUMMARY Cardiovascular disease disproportionately affects older adults. Treatment of older patients with cardiovascular disease requires addressing many ethical and end-of-life issues. The ethical issues include assessment of decision-making capacity, surrogacy and advance directives, decisions related to cardiopulmonary resuscitation, and effective communication with patients. Palliative and end-of-life issues are common in the management of heart failure, acute stroke, and in caring for stroke survivors. Advanced surgical interventions and implantable devices have changed the course of coronary artery disease, advanced heart failure, and valvular disease. Such interventions are increasingly applied to older and more medically complicated patients. As the population ages and technology advances, issues of distributive justice and access to care will challenge health systems worldwide.
