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A Focus on the Heart for Older Patients

The first geriatric cardiology clinic in New York opened at N.Y.U. Langone Medical Center in August. It’s different.

For starters, an older patient’s first visit with cardiologist Dr. John A. Dodson, the program’s director, takes a full hour. Beyond taking a complete history, Dr. Dodson looks for frailty by measuring things like gait and grip strength and administers a short test of cognitive ability – things geriatricians routinely do and cardiologists mostly don’t.

“The No. 1 difference is time,” he told me in an interview. “To be able to spend an hour with a new patient is a gift.”

In January, when a pharmacist joins the program, Dr. Dodson will start asking patients to bring in all their prescription drug bottles for review. “They may be taking redundant medications or the wrong medications,” he explained. “Where we can, we will peel away what’s not essential.”

The conversation expands to include less medical topics, too: the patient’s goals, the extent of family support, end-of-life preferences.

The N.Y.U. program is one of only a handful of geriatric cardiology programs that have sprouted up around the country, including the first (so far as we know) at Vanderbilt University Medical Center, in 2012, and a similar program at the University of Pittsburgh Medical Center. More are likely to follow.

At Vanderbilt, “I talk about living wills and health care proxies and why they’re important,” said Dr. Susan Bell, a cardiologist and geriatrician the clinic director. “Is this the person who wants quality of life or the person who wants to push for longevity as much as possible?”

This is mostly common sense – treating an individual, rather than an organ – but it is particularly crucial for older adults.

Dr. Dodson’s patients at N.Y.U. are mostly in their 80s; the oldest is 96. Whatever has gone wrong with their cardiovascular systems, they are usually also coping with several other chronic conditions and disabilities, from diabetes to hearing loss. They take a raft of drugs. They may not cope well with procedures and regimens effective for younger patients.

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