BACKGROUND:Practitioners recommending transcatheter aortic valve implantation (TAVI) currently lack reliable tools to predict periprocedural risk of ischaemic stroke. AIMS:We aimed to develop and internally validate a clinical risk score to accurately stratify this risk. METHODS:Using data from the nationwide, multicentre FRANCE-TAVI registry, we developed a clinical predictive risk score for 30-day ischaemic stroke post-TAVI using multivariable logistic regression analysis. The model was internally validated through cross-validation techniques. RESULTS:Among 62,747 patients, 1712 (2.7%) experienced ischaemic stroke within 30 days. Nine clinical predictors were identified: female sex, age >85 years, weight <60kg, symptomatic status, history of stroke or transient ischaemic attack, multiple (i.e. >1) episodes of acute heart failure, severe mobility reduction, diabetes and creatinine clearance <60mL/min. The resulting scoring model demonstrated good accuracy (Brier score 0.18), moderate discrimination (C-index 0.63) and excellent calibration as assessed by calibration plots, calibration-in-the-large and calibration slope. The score categorized patients into low - (90.2% of the population), intermediate - (8.0%) and high-risk (1.8%) groups. Observed stroke rates increased progressively across these groups, from 2.25% in the low-risk group to 6.51% in the intermediate-risk group and 10.10% in the high-risk group. CONCLUSIONS:This newly developed STRAT score is a clinical, practical and effective tool for predicting early ischaemic stroke in patients undergoing TAVI. It was derived and internally validated in the FRANCE-TAVI registry and may help tailor preventive strategies. Further studies are necessary to externally validate this score and evaluate its impact on clinical decision-making.

Device deactivation in patients with heart failure is an increasingly relevant clinical and ethical challenge as the use of cardiovascular implantable electronic devices expands. Current guidelines affirm the ethical and legal permissibility of deactivating life-sustaining devices, including implantable cardioverter-defibrillators, pacemakers, and mechanical circulatory support systems, when requested by patients or surrogates with decision-making capacity. Importantly, guidelines from professional societies recommend that discussions about device deactivation be included in the pre-implantation consent process. However, clinical practice reveals persistent gaps in advance care planning, with device deactivation discussions remaining infrequent. Deactivating implantable cardioverter defibrillators can prevent painful and unnecessary shocks at the end of life, which may otherwise prolong dying without improving quality of life. Multidisciplinary involvement, including palliative care consultation, is essential to support patient-centered decision-making and symptom management. This review synthesizes the latest evidence and consensus on device deactivation in heart failure, emphasizing the need for communication, initiated early in the disease course, as well as individualized care, and integration of patient preferences throughout the disease trajectory.

Les conditions particulières d’exercice de la réanimation peuvent entrainer, parmi les professionnels, une altération effective ou ressentie de la Qualité de Vie et des conditions au Travail (QVcT) se traduisant par une perte de sens du soin et des conflits de valeurs. Il apparait donc indispensable de développer une culture de service et un climat éthique au sein des services de réanimation autour d’un corpus de valeurs, identifiées par les professionnels comme un guide ou une boussole garant de la qualité et de la sécurité des soins. Cette démarche nécessite de s’appuyer sur une dynamique participative anticipée et interdisciplinaire, impliquant patients, soignants, proches, médecins référents et consultants afin de faciliter les prises de décisions, l’autonomisation des professionnels, les pratiques et les organisations, avec le respect mutuel des prises de paroles et des positionnements des acteurs. Ainsi, il s’agira de limiter l’installation d’un silence éthique au profit d’un relativisme éthique en améliorant la communication et la dispensation d’informations claires, adaptées et compréhensibles pour garantir la cohésion et l’engagement des équipes au sein des services de réanimation. Ainsi, les valeurs éthiques du soin seront reconnues tout au long du parcours du patient en réanimation.

Postintensive care syndrome (PICS) encompasses physical, psychological, and cognitive sequelae following an intensive care unit (ICU) stay, with repercussions also extending to patients’ families (PICS-F). Beyond health-related outcomes, ICU survivors frequently face social and economic challenges, including reduced income, unemployment, social isolation, and increased dependence on welfare. Socioeconomic status (SES), defined by access to material, human, and social resources, is a major determinant of health inequities and influences both the risk and severity of PICS. Evidence suggests that low SES is associated with poorer quality of life, increased need for long-term care, and higher mortality after ICU discharge. Recent studies show that educational level and employment status significantly impact long-term recovery, underlining the interaction between social vulnerability and PICS. The ongoing SOPICS trial will further explore these associations using the EPICES score to identify high-risk patients. Integrating SES into PICS management is essential, with social workers playing a central role in coordinating discharge planning, welfare access, and support services. Future research should assess the impact of tailored social interventions on PICS outcomes, aiming to mitigate inequities and improve reintegration after critical illness.

Background/Objectives: Adults under legal protection experience management delays and prolonged hospitalization. This study investigated whether ICU outcomes differ between patients with versus without legal protection. Methods: This retrospective, single-center study evaluated patients admitted to a French ICU (July 2015-July 2023). Protected patients were compared to autonomous controls matched 1:3 by age and admission year. Results: Of the 1051 patients included, 266 (25.3%) were under legal protection. The protected group had a higher proportion of women (43.2% vs. 35.7%, p = 0.025), received renal replacement therapy less frequently (8.6% vs. 15.4%, p = 0.007), and required non-invasive ventilation more frequently (25.2% vs. 17.2%, p = 0.004) than controls. Three-month mortality was 38.7% in controls versus 33.1% in protected patients, showing no significant difference after multivariable adjustment for 6 prespecified clinical variables (aOR 0.816, 95% CI 0.564 to 1.180). In the adjusted model, higher SAPS II scores and vasopressor use were significantly associated with increased 3-month mortality, whereas non-invasive ventilation and non-respiratory admission indications (sepsis, renal failure, trauma) were associated with decreased mortality. Conclusions: No significant association was observed between the presence of a legal protection measure prior to ICU admission and 3-month patient mortality. However, these results must be interpreted with caution due to a potential lack of statistical power. Additionally, legally protected patients were observed to receive renal replacement therapy less frequently, whereas non-invasive ventilation was utilized more frequently. Within this context, further research is required to evaluate the impact of legal protection status on the formal collegial deliberations that lead to decisions regarding the limitation of life-sustaining treatments.

L’évolution du métier de réanimateur doit prendre en compte le bien-être physique et psychologique ainsi que les besoins sociaux des patients et de leurs proches grâce à une humanisation du soin : « le care », tout en considérant les besoins de celles et ceux qui soignent. Cette évolution doit permettre une transition entre le fait de « faire de la réanimation » aux aspects techniques indispensables mais potentiellement « deshumanisants », et le fait de « devenir réanimateur », état d’esprit qui nécessite formation, compagnonnage (acquisition d’un savoir expérientiel) et prise en compte d’une notion de plus en plus prégnante qui est celle de « service rendu » au patient. Ainsi, évoluer de la réanimation proprement dite à « la non-réanimation », à la « dé-réanimation » et au « suivi post-réanimation » constitue la base de la réflexion autour du métier de réanimateur. Cette démarche contribuera à prévenir, grâce aux réflexions partagées et multidisciplinaires, des soins jugés inutiles, une qualité empêchée et une perte de sens au travail, source de souffrance psychique et de perte d’attractivité et de diminution de la fidélisation aux métiers des soins critiques.

Background The extravascular implantable cardioverter-defibrillator (EV-ICD) is a novel nontransvenous system designed to prevent sudden cardiac death while avoiding complications associated with transvenous leads. Insertion after prior sternotomy is currently considered contraindicated and to our knowledge has not previously been reported. Case Summary A 68-year-old man with prior Bentall procedure developed anthracycline-induced cardiomyopathy requiring ICD insertion for primary prevention. The need to preserve venous access and failed subcutaneous ICD screening limited the available options. Preprocedural imaging demonstrated a measurable retrosternal space without significant adhesions. EV-ICD insertion was successfully performed without resistance during retrosternal tunneling, and the lead was appropriately positioned. Defibrillation testing was successful, and the postoperative course was uneventful. Discussion Median sternotomy may result in variable retrosternal adhesions and anatomical changes. In this setting, insertion of a retrosternal defibrillation lead requires careful anatomical assessment and meticulous technique. Take-Home Message EV-ICD insertion may be feasible in carefully selected patients with prior sternotomy.

Prioritizing research is essential to reduce waste, particularly in palliative care, a field with historically limited investment. To identify and rank the top 10 unanswered palliative care research questions in France according to patients, caregivers, healthcare professionals and volunteers, a three-step priority-setting study was conducted between January 23, 2022, and September 24, 2024, based on the “Palliative and End of Life Care Research Priorities Project.” Step 1 identified unanswered questions through an online unstructured questionnaire available online for 6 months using Limesurvey®. A multidisciplinary steering committee comprising two board-certified palliative care physicians, two methodologists, three nurses, a sociologist, an anthropologist and one information specialist, deleted duplicates, modified questions using the PICO format, did a literature review for each question using four Database. Step 1 included patients, caregivers, healthcare professionals and volunteers with at least a 2-year palliative care experience, recruited via the national end-of-life research platform and the SFAP (National Society for Palliative Care). Step 2 consisted of a six-month first-round prioritization survey. Step 2 have the same inclusion criteria as phase 1. Recruitment was identical to phase 1 and via 10 teaching hospitals. Priorities were established by consensus using average rankings based on the Borda method. Step 3 used a nominal group to reach consensus on the top 10 priorities. Inclusion criteria and recruitment were identical to phase 1 and 2. Patients were recruited via Grenoble teaching hospital. Step 3 involved 17 participants (3 patients, 5 family caregivers, 4 healthcare professionals, 5 volunteers). Verbatim discussions were analyzed using triangulation to identify major and minor themes underlying prioritization decisions. In Step 1, 560 verbatim responses generated 482 research questions, of which 32 were already addressed in the literature. Step 2 analyzed 413 questionnaires, with euthanasia emerging as the top theme. In Step 3, the highest-ranked question focused on improving patient information and supporting informed consent at the end of life. Improving patient information emerged as a central issue, relevant to patient care, societal decision-making, and efforts to enhance patient involvement in palliative care research. Clinical teams and researchers need to address the unanswered questions quickly.

A growing body of research is focusing on how music, technology, and neuroscience can converge to promote healthy ageing and counteract pathological decline. In particular, music interventions for older adults have been garnering increasing attention, with numerous reports showing positive effects of music on various health outcomes, including psychological well-being, cognitive function, physiological responses, quality of life, and overall well-being. In this context, the European Interdisciplinary Council on Ageing (EICA) in collaboration with the “Age-It” project (Ageing well in an Ageing Society), specifically, the work package 1 of Spoke 8, run by the University of Bari, and the “RAISE” project (Robotic and Artificial Intelligence for Socio-economic Empowerment) run by the E.O. Galliera Hospitals, Genoa, Italy, convened a 2-day meeting in June 2025 to review the state of the evidence on the relationship between music and health. Speakers were tasked with exploring how music, neuroscience, technology, and environmental design contribute to understanding ageing and to developing interventions that support healthy ageing. This report presents the Executive Summary of the proceedings of this meeting.

To map and characterise major transnational initiatives in education and training in geriatrics, and to explore complementarities to support a more coherent and equitable global framework. Multiple transnational programmes operate across a wide spectrum of structures, educational approaches, and content, reflecting diverse regional priorities and stages of development. Coordinated collaboration amongst initiatives is essential to build global capacity, promote equity, and ensure sustainability in geriatrics education and workforce development. To map and characterise major transnational initiatives in geriatrics education and training, and explore complementarities as a basis for a more integrated and equitable global framework. A mapping exercise and expert consultation were undertaken by the European Geriatric Medicine Society (EuGMS) Special Interest Group on Education and Training between January and October 2025, including a meeting of international experts during the Twenty-First EuGMS Congress in Reykjavík. Eligible initiatives operated across national borders with an explicit mandate in education and training related to geriatrics and were not confined to a specific topic or subspecialty. Each initiative was profiled by scope, target audience, and contributions, and classified within a three-tier framework: (1) foundational capacity-building, (2) professional and interprofessional development, and (3) leadership and specialist advancement. Seventeen initiatives were identified. Tier 1 included the International Federation on Ageing (IFA), International Institute on Ageing, United Nations–Malta (INIA), PAHO’s ACAPEM (Basic), ASEAN’s Centre for Active Ageing and Innovation (ASEAN–ACAI), IAGG’s e-Training in Gerontology and Geriatrics (e-TRIGGER) programmes, WHO’s Integrated Care for Older People (WHO ICOPE approach), and AfriAGE. Tier 2 included the IAGG, EuGMS, EICA, PROGRAMMING CA2112, Victorian Geriatric Medicine Training Programme (VGMTP), and ACAPEM (Intermediate); and Tier 3 was represented by leadership academies (EAMA, ALMA, MEAMA/MENAAA, and AAMA), and UEMS–GMS. Collectively, these programmes form a considerably disjointed but potentially complementary global ecosystem for geriatrics education. Greater mutual awareness and alignment, anchored in equity and interprofessional inclusion, could enhance efficiency and sustainability in developing the global geriatrics workforce.

This article explores the traditional Mediterranean and Cantonese diets through historical, cultural, and scientific lenses. Drawing from expert presentations delivered during a multi-day international symposium, we examine the culinary practices, nutritional components, and health implications of both dietary traditions. The comparative analysis addresses cardiovascular and metabolic health, cancer prevention, functional foods, public policy, and the emerging role of traditional foods in modern preventive medicine. By analyzing the synergy between dietary elements and lifestyle factors, we highlight how these long-standing traditions can inform contemporary strategies for health promotion and chronic disease prevention.

To improve cancer patient management, international recommendations underline the importance of integrating palliative care (PC) into oncology, and education of future oncologists is key to achieving this. In France, no study has evaluated PC training for oncology residents. This study aims to identify educational needs in PC among French oncology residents and to assess the acceptability of changing their medical training. A nationwide, descriptive, mixed-methods study was performed between 2021 and 2023. The first qualitative phase used semi-structured interviews with oncology residents to identify their training needs in PC. The second quantitative phase performed a nationwide online survey among all French oncology residents. The least trained residents were the least keen to receive training, expressing a reductive definition of PC to the end of life, as well as a non-collaborative and integrated vision between PC and oncology. The questionnaire had a participation rate of 24

We investigated why cardiologists request palliative care and described the palliative care team’s responses. Among 142 patients referred from cardiology to palliative care services, 30

Cardiovascular and infectious diseases both feature among the leading causes of death among men and women in the world. The pathophysiological pathways of infection and cardiovascular disease intersect, and there is a bidirectional relationship between the two. Vaccines are available for the most common infectious diseases affecting older adults, such as influenza, pertussis, pneumococcal disease, herpes zoster, COVID and respiratory syncytial virus (RSV). In many countries, these vaccines are recommended systematically for older adults and any adults with comorbidities, who are also those most likely to suffer from cardiovascular disease. There is a large body of evidence attesting to the benefits of vaccination on cardio- and cerebrovascular health. The European Interdisciplinary Council for Aging (EICA) and the Italian Society for Cardiovascular Prevention (Società Italiana per la Prevenzione Cardiovascolare, SIPREC) convened a 2-day meeting in June 2024 to review the state of the evidence on the relationship between cardio- and cerebrovascular health and the most common infectious diseases, and the role of vaccines in preventing both infection and its adverse consequences in terms of cardiovascular and cerebrovascular outcomes. We present here the Executive Summary of the proceedings of this meeting.

There is a growing need for palliative care (PC) among patients with cardiovascular disease (CVD), as population ageing and technological progress bolster the numbers of patients living with chronic forms of CVD. PC can provide support and benefits in areas that are not necessarily addressed by medical therapy. However, many healthcare providers, and cardiologists in particular, struggle with identifying the right time to introduce PC in the care trajectory of patients with CVD, especially in heart failure, where the clinical course is punctuated by highs and lows, with periods of stability that may last several months to years. The use of validated assessment tools to recognize PC needs of people living with CVD is recommended, but clinicians may be unaware of existing instruments and criteria for PC referral, or when and how to use them. We report here a narrative review of the literature, with the aim of providing an overview of useful tools for the identification and assessment of palliative care needs among patients suffering from cardiovascular disease with a view to improving their care process. We further discuss the overall suitability of available tools, as well as issues specifically related to implantable cardiac devices at the end-of-life.

Background: The relationship between obesity (defined as body mass index [BMI] >= 30 kg/m2) and mortality in venous thromboembolism remains controversial. Objectives: We aimed to compare outcomes after pulmonary embolism (PE) between patients with obesity and nonobese, nonunderweight patients. Methods: Using a multicenter registry of prospectively recorded individual patient data, we compared outcome rates using multivariable logistic or Cox regression for 30-day and 6-month outcomes respectively (etiologic analysis). We assessed the incremental value of adding BMI information on top of the 30-day European Society of Cardiology (ESC) prognostic algorithm (prognostic analysis). Results: We included 2390 patients with BMI of >= 18.5 kg/m2 (mean age, 66.9 +/- 16.8 years; 1188 men [49.7%]); 686 patients [28.7%] were in the obese group. Mortality rates were significantly lower in patients with obesity than that in patients who were nonobese at 30 days (3.2% [95% CI, 2.0-4.8] vs 5.9% [95% CI, 4.8-7.1]), and 6 months (8.1% [95% CI, 6.2-10.4] vs 16.3% [95% CI, 14.6-18.1]). Rates of secondary nonfatal outcomes (including bleeding, recurrent venous thromboembolism, myocardial infarction, and stroke) did not differ between groups. The addition of the obesity information on top of the ESC prognostic model improved global model fit and discriminatory (Harrell C index from 0.636 to 0.657; P = .07) and calibration capacities (P (Hosmer-Lemeshow) = .02 vs .13), yielding significant reclassification (ie, 10.3%) based on the observed mortality rates with the ESC model as reference. Findings were confirmed in an external validation using 35,796 patients with PE from the RIETE registry. Conclusion: We present evidence indicating lower early-and mid-term mortality after PE in patients classified as obese based on BMI, compared with nonobese, nonunderweight patients. BMI should likely be incorporated into algorithms or scoring systems for predicting early mortality following PE.

Musculoskeletal disorders are a significant public health burden concern, projected to increase in the coming decades, and will substantially contribute to the rising prevalence of functional impairment, frailty and disability in a growing global population. Since persons with musculoskeletal disorders tend to have immune dysfunction, inflammation or be taking immunosuppressive medication, prevention of vaccine-preventable diseases (VPDs) in this group is particularly important. The European Interdisciplinary Council for Aging (EICA) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) jointly convened a 2-day in-person and virtual meeting on 26–27 September 2023, to review the state of the evidence on the link between musculoskeletal diseases, infections and vaccines. We present here the Executive Summary of the proceedings of this meeting. We review the importance of physical activity in preventing or mitigating both musculoskeletal diseases and risk of infection. We summarize current knowledge of the impact of common VPDs on the development and progression of musculoskeletal diseases, and the role of selected vaccines in preventing onset and worsening of frailty and disability in these individuals. This report summarizes the evidence presented at the two-day meeting, highlighting the need to raise awareness among scientists, healthcare professionals, decision-makers, civil society and the general public about the long-term sequelae of VPDs, with focus on the health status of older patients with musculoskeletal diseases.

This paper reports the evaluation by trainees of the innovative online education initiative known as the eTRIGGER (e-TRaining In Gerontology and Geriatrics) program, which targets healthcare professionals working with older adults in Africa, the Middle East, and Europe (AFMEE course) and in Asia-Oceania (ASIO). The eTRIGGER programs are implemented under the auspices of the International Association of Gerontology and Geriatrics (IAGG). The first year of teaching of the AFMEE program (May 2023 to April 2024) and the third year of the ASIO program (January to December 2024) were evaluated by the students using a satisfaction survey implemented at the end of the year of teaching. Almost all trainees reported that the course met their personal objectives. A significant majority reported applying acquired knowledge directly (AFMEE, 75 %; ASIO, 78 %) and indirectly (AFMEE, 30 %; ASIO, 42 %) in their daily work. Over half reported improved skills in caring for older adults (AFMEE 65 %, ASIO 52 %). Around one-fifth reported a job or career promotion after course completion (AFMEE 21 %, ASIO 17 %). The evaluation highlights the significant impact and success of the e-TRIGGER program for most alumni. Key challenges of this innovative teaching program include ensuring financial sustainability and addressing specific training needs related to long-term care, dementia management, and technology integration. Future perspectives include expanding the program to Latin America (IAGG e-TRIGGER LATAM) and developing complementary, specialized short courses on specific areas of geriatric medicine and gerontology.