ACC says CVD care should look beyond chronological age

Clinical takeaway: In older adults with cardiovascular disease, consider cognitive impairment and frailty when making treatment decisions—not chronological age alone. Screen when feasible, optimize cardiovascular risk factors and medications, and prioritize exercise, nutrition, rehabilitation, and preservation of function.

Cardiovascular disease rarely occurs in isolation in older adults. An estimated one-third of cardiology patients have some degree of cognitive impairment, while frailty is common and can affect treatment tolerance, medication adherence, procedural recovery, and independence. A new American College of Cardiology (ACC) Scientific Statement calls for an “aging-informed” approach that incorporates these factors into routine cardiovascular care.

The statement recommends screening for cognitive impairment and frailty in outpatient settings and after hospitalization when feasible. Brief cognitive tools such as the Mini-Cog, MoCA, MMSE, or SLUMS can be considered, with input from caregivers or other informants when appropriate. Gait speed and grip strength are highlighted as particularly useful measures of physical vulnerability.

When cognitive impairment is suspected, clinicians should evaluate potentially contributing conditions or deficiencies, optimize problems such as heart failure and poorly controlled hypertension, and consider brain imaging and referral. Rapid cognitive change that could represent delirium warrants more urgent evaluation.

Medication management is also central. The ACC emphasizes appropriate blood pressure control to protect cardiovascular and cognitive health, while cautioning that targets may need to be more lenient in patients with advanced CVD and severe frailty or cognitive impairment. Statins remain important for cardiovascular prevention and may modestly reduce dementia risk, although evidence for cognitive benefit is largely observational. Oral anticoagulation remains beneficial for stroke prevention in older adults with atrial fibrillation despite increased bleeding risk, with individualized assessment and shared decision-making recommended.

The statement also urges clinicians to review medication burden and deprescribe potentially inappropriate drugs when possible. For patients taking GLP-1 receptor agonists for obesity or diabetes, adequate protein intake and resistance exercise may be particularly important because of concerns about loss of muscle mass in older adults.

Beyond medications, multicomponent strategies combining exercise and nutritional optimization are emphasized. Cardiac rehabilitation—including home-based or adapted programs when needed—is highlighted as a key tool for maintaining or restoring strength, balance, mobility, and independence.

“For many older adults, the most important outcomes are not prevention of cardiovascular events, but maintaining cognitive health, physical function, and independence,” said writing committee chair Karen P. Alexander, MD, FACC, professor of medicine at Duke University School of Medicine.

Source: Alexander KP, et al. (2026 Aug 10) J Am Coll Cardiol. Cognitive impairment and frailty in older adults with cardiovascular disease: 2026 ACC scientific statement