Background: The rapid ageing of the cardiovascular population has profoundly transformed clinical practice, with an increasing proportion of patients presenting advanced age, frailty, multimorbidity, and functional vulnerability. Conventional cardiology models, largely derived from younger and selected populations, often fail to adequately address the complexity of cardiovascular care in older adults. Despite the growing development of cardiogeriatrics, the core competencies required for contemporary geriatric cardiology practice remain insufficiently defined. Methods: This narrative review synthesises evidence from cardiology, geriatrics, heart failure, and the palliative care literature, complemented by clinical expertise in integrated cardiogeriatric care pathways, to identify key competencies relevant to the care of older adults with cardiovascular disease. Results: Four major domains of geriatric cardiology competencies were identified: (1) advanced cardiovascular expertise adapted to ageing physiology, frailty, and multimorbidity; (2) integration of comprehensive geriatric assessment into cardiovascular decision-making; (3) a dedicated cardiogeriatric communication mindset supporting shared decision-making under prognostic uncertainty; and (4) system-based competencies focused on multidisciplinary coordination, care transitions, and therapeutic proportionality. Conclusions: Defining the core competencies of the geriatric cardiologist is essential to addressing the clinical and organisational challenges of an ageing cardiovascular population. This framework provides a pragmatic foundation for clinical practice, education, and future research, supporting integrated cardiogeriatric care models aligned with patient-centred outcomes.

Background: Advanced heart failure (HF) in very old patients follows an unpredictable trajectory marked by recurrent decompensations, progressive functional decline, and high mortality. In this population, decision-making regarding goals of care and treatment proportionality is particularly complex due to multimorbidity, frailty, cognitive vulnerability, and prognostic uncertainty, and remains insufficiently addressed by conventional disease-centred heart failure pathways. Methods: This narrative review synthesizes current evidence from heart-failure guidelines, geriatric medicine, and palliative care literature to propose a cardiogeriatric framework for end-of-life decision-making in advanced HF. Results: In older adults, functional decline and geriatric vulnerability often progress independently of cardiac parameters, limiting the relevance of prognosis-based thresholds. The palliative turning point should be understood as a multidimensional process resulting from converging cardiological, geriatric, organizational, and patient-reported signals. Therapeutic decisions should be guided by proportionality between expected benefit, treatment burden, and patient priorities. Longitudinal, iterative communication is essential to align care with evolving goals. Conclusions: A cardiogeriatric approach integrating cardiology, geriatrics, and palliative principles supports timely palliative integration, shared decision-making, and coordinated care in very old patients with advanced HF.

Severe tricuspid regurgitation (TR) is increasingly recognised as a major cause of morbidity in older adults with heart failure (HF). Conventional surgical repair or replacement carries prohibitive risks in frail patients, leading to therapeutic inertia and progressive loss of function. The development of transcatheter tricuspid edge-to-edge repair (T-TEER) offers a less invasive, guideline-supported option for selected individuals previously considered inoperable. This narrative review summarises contemporary evidence and explores the specific challenges of T-TEER in frail older adults through a cardiogeriatric lens. It integrates epidemiology, diagnostic complexity, frailty and cognitive assessment, procedural considerations, and multidisciplinary coordination. Randomised trials and real-world registries consistently demonstrate symptomatic and functional improvements with acceptable procedural risk in octogenarians. Drawing on the experience of the Cardiogeriatric Department, Hôpital La Porte Verte (Versailles, France), this review outlines an integrated model embedding geriatrics, advanced nursing, and telemonitoring (Satelia^® Cardio) within HF care. This approach aligns with the Age-Friendly Health Systems framework and the ESC 2021 Heart Failure Guidelines, emphasising functional preservation and patient-centred priorities.

Remote monitoring is increasingly used in heart failure care, but most programs rely on uniform models that insufficiently reflect the heterogeneity of older adults, particularly with respect to frailty, cognitive impairment, functional dependency, and caregiver availability. This viewpoint argues that frailty should be considered a central determinant of remote monitoring design in older adults with heart failure, rather than a secondary modifier of conventional digital health pathways. Drawing on evidence from heart failure telemonitoring, geriatric medicine, and real-world cardiogeriatric experience, we propose a frailty-adaptive framework structured around four clinical trajectories: robust, prefrail, frail, and palliative. Each trajectory is associated with distinct monitoring objectives, workflow adaptations, and response pathways. Robust patients may benefit primarily from optimization, self-management support, and guideline-directed therapy titration; prefrail patients from early detection of deterioration and functional decline; frail patients from proxy-supported reporting, nurse-led triage, and rapid-access cardiogeriatric reassessment; and palliative patients from simplified symptom-guided monitoring focused on comfort, hospitalization avoidance, and caregiver support. This framework reframes remote monitoring as a stratified clinical process rather than a purely technological intervention. By aligning digital strategies with frailty status, functional capacity, and care goals, frailty-adaptive remote monitoring may improve clinical relevance, promote digital health equity, and support more sustainable models of care for older adults with heart failure.