Short communication and clear content of geriatric recommendations matter! Evaluation of geriatric recommendation acceptance in patients aged ≥ 85 years hospitalized for cardiac conditions

As patients with cardiovascular disease age, the need for cardiogeriatric care grows. Therefore, we aimed to identify facilitators and hindrances to the implementation of cardiogeriatric care by analysing geriatric recommendations content and acceptance rates. This retrospective cohort study included 100 patients aged > 85 years who received geriatric consultation and were admitted to a cardiology department. A random sample was generated, of which half received proactive geriatric consultation and half received usual care (geriatric consultation upon request). The recommendation content was categorized into geriatric domains (physical, mental, functional, social, and existential), and recommendation uptake was categorized into seven categories (e.g., accepted, declined by patient). Additionally, factors associated with acceptance rates were analysed using univariate logistic regression. The study population (mean age 88, 60% female) received 310 recommendations of which 56% were accepted. The acceptance rate was significantly higher if recommendations belonged to the functional (OR 3.10 (95% CI 1.41-6.82)), social (OR 5.55 (95% CI 2.40-13.00)), and existential domain (OR 6.09 (95% CI 2.62-14.16)) compared to the physical domain. Furthermore, higher acceptance rates were observed if recommendations were communicated verbally instead of electronically (OR 2.16 (95% CI 1.30-6.70)), when a clear tone was used instead of a doubtful one (OR 1.90 (95% CI 1.01-3.56)), and if the recommendation was concisely documented (OR 1.11 (95% CI 1.04-1.20) per average 10 words decrease). In this study, the acceptance rate of geriatric recommendations for older patients with cardiac disease was low. Recommendations regarding the functional, social, and existential domains had the highest acceptance rates. To improve acceptance rates, recommendations should be communicated verbally, documented concisely, and a doubtful tone should be avoided.