ABSTRACT
Cardiovascular disease disproportionately affects older adults. 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. However, prognostication and outcomes can be unclear in elderly patients due to the nature of cardiovascular disease and presence of comorbidities. Decisions should account for patients’ goals and preferences. 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. Meeting the needs of patients with heart failure and stroke in the advanced stages may require multidisciplinary teams including palliative care. As the population ages and technology advances, issues of distributive justice and access to care will challenge health systems worldwide.
