Description
The patients the trials excluded
Cardiology’s evidence base was largely built on patients considerably younger and fitter than the ones now filling its clinics. Extrapolating to a frail eighty-eight-year-old on eleven medications is not a minor adjustment — it is a different clinical problem, and the guideline offers little help.
These 274 pages treat that as the subject rather than as a caveat.
Frailty as a clinical variable
Handled first, because it predicts outcome better than age and is rarely measured. The volume is practical about which instruments are usable in a busy clinic and what each score actually changes about a decision.
Where presentation differs
Infarction without chest pain. Heart failure presenting as confusion or falls. Aortic stenosis attributed to ageing for two years. Atrial fibrillation found incidentally after a stroke that should have been prevented. Each is common, each is missed routinely, and each has a recognisable pattern.
The decisions that are genuinely hard
Anticoagulation when both stroke and bleeding risk are high — which is most of this population. Polypharmacy and structured deprescribing. Revascularisation and valve intervention in the very old, including honest treatment of when TAVI helps and when it prolongs a decline. Ceilings of care, and how to discuss them without abandoning the patient.
Academy placement
Recommended across all tracks, and required on the general track. This population is now the majority of most cardiology clinics.
PDF, lifetime access, via CardiologyBooks.com.
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