Risk stratification in very old adults: how to best gauge risk as the basis of management choices for patients aged over 80.

Cardiovascular disease (CVD) is the leading cause of mortality in older adults, however, in the elderly accurate stratification of CVD risk to guide management decisions is challenging due to the heterogeneity of the population. Conventional assessment of CVD and therapeutic risk is based on extrapolation of guidelines developed from evidence demonstrated in younger individuals and fails to weight the increased burden of complications and multimorbidity. Using a comprehensive geriatric based assessment of older adults with CVD that includes an estimation of complexity of multimorbidity as well as traditional risk assessment provides a patient centered approach that allows for management decisions congruent with patient preferences. This review examines the complexity of risk stratification in adults over 80, assessment methods to augment current tools and the basis of management decisions to optimize patient and family centered goals.