# Who Should Be the Cardiogeriatrician? A Competency-Based Perspective for an Ageing Cardiovascular Population

## TL;DR

This paper explores who should care for older adults with complex heart conditions, emphasizing skills over job titles.

## Contribution

It introduces a competency-based framework for cardiogeriatric care, focusing on skills like frailty interpretation and goal-concordant decision-making.

## Key findings

- Current cardiogeriatric models are often role-based rather than competency-based.
- A competency-based approach supports collaborative and patient-centered care for aging populations.
- Cardiogeriatric expertise can be embodied by various professional profiles with defined competencies.

## Abstract

Background: Population ageing is reshaping cardiovascular medicine, with older adults increasingly presenting with heart failure, atrial fibrillation, and structural heart disease. Their management is frequently complicated by frailty, multimorbidity, functional impairment, and competing priorities, challenging traditional disease-centred cardiovascular models. Objective: To address who should act as the cardiogeriatrician using a competency-based perspective focused on the clinical skills and decision-making capacities required to care for older frail adults. Methods: Narrative review of PubMed/MEDLINE literature integrating cardiology, geriatrics, and health services research, including guidelines, consensus statements, observational studies, and conceptual frameworks. Results: Cardiogeriatric care models vary widely and are often defined by professional roles rather than competencies. A competency-based framework better captures core requirements, including frailty-informed interpretation, proportionality of care, trajectory-based assessment, and goal-concordant decision-making. Cardiogeriatric expertise may be embodied by different professional profiles. One workable profile is a geriatrician with sustained cardiovascular practice and clearly defined competencies. Cardiology expertise remains essential for diagnostic confirmation, complex decision-making, and interventional care. Conclusions: A competency-based conceptualisation of cardiogeriatrics supports collaborative, proportionate, and patient-centred cardiovascular care in ageing populations, without redefining professional boundaries.