Cross-material continuous tool wear prediction is difficult because a model must preserve the physical wear scale, not only align high-dimensional sensor features. This limitation is critical in milling, where the target variable is the continuous flank wear width (VB) and material shift can distort the mapping from sensor response to wear magnitude. We address this problem by recasting cross-domain tool wear prediction as monotone wear-scale adaptation. We propose Multi-Physics Monotone Score Transport (MPMST), a monotone score transport framework that constructs a tool-wear-oriented score from sensor-derived candidate cues, transports the target-domain score onto the source-domain wear scale, and then predicts wear through isotonic regression. We also evaluate One-Physics Monotone Score Transport (OPMST), a force-only variant that uses the same score-transport pipeline with a restricted cue family. On Mondragon Unibertsitatea-Tool Condition Monitoring (MU-TCM) with two cross-material transfer tasks, the validation-driven MPMST configuration reduces mean absolute error by approximately 63% relative to Correlation Alignment (CORAL) and by approximately 31% relative to a physics-informed Gaussian process baseline. The results support monotone score construction and score transport as practical mechanisms for continuous tool wear prediction under domain shift, while also showing that MU-TCM is strongly force dominated.
Social gradients are consistently associated with variation in health outcomes, including infectious disease. However, distinguishing between social gradients in antigen exposure versus social gradients in susceptibility remains challenging. Here, we use a nonhuman primate model for chronic social stress to investigate how social status affects the influenza vaccine-induced adaptive immune response. We first manipulated the social status of female rhesus macaques and then tested the response to influenza antigens in naïve individuals and after secondary exposure. Higher social status at the time of first exposure, but not at the time of secondary exposure, predicted stronger antibody responses to both exposures. Social status also drove gene expression differences in adaptive immune pathways, and genes that predicted the magnitude of the antibody response overlapped with those linked to social status. Thus, social gradients shape the adaptive immune response in a temporally dependent manner, with particular sensitivity at the time of initial antigen exposure.
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Heart failure in older adults increasingly occurs in the context of frailty, multimorbidity, and declining physiological reserve. In this population, therapeutic efficacy demonstrated in selected clinical trial populations does not automatically translate into meaningful clinical benefit. This discrepancy may create tension between guideline-driven care and goal-concordant prescribing. This narrative review proposes a conceptual framework to distinguish therapeutic efficacy from clinical relevance in ageing heart failure populations. Using tafamidis for transthyretin cardiac amyloidosis and apixaban for atrial fibrillation as illustrative paradigms, we examine how frailty severity, competing risks, life expectancy, and therapy-specific time-to-benefit influence the likelihood that a treatment will provide meaningful benefit for an individual patient. Disease-modifying therapies with delayed benefit may lose proportionality when lag-time-to-benefit exceeds the patient's anticipated window of preserved survival or functional autonomy. In contrast, preventive strategies that rapidly reduce autonomy-threatening events may retain broader clinical relevance across vulnerability strata, although individualized reassessment remains essential. We introduce the concept of temporal therapeutic mismatch, defined as a situation in which expected therapeutic benefit occurs beyond the patient's remaining functional trajectory or life expectancy. A pragmatic framework integrating frailty severity, estimated life expectancy, competing risks, therapy-specific time-to-benefit, and patient-defined goals is proposed to support proportional prescribing. In ageing cardiovascular populations, high-quality care requires moving beyond efficacy alone toward frailty-informed clinical relevance. Structured reassessment-including consideration of non-initiation or deprescribing when appropriate-represents a key component of patient-centered cardiovascular care.
Pharmacological treatment of fragility fractures is a strategy used to prevent secondary fractures. Our aim was to evaluate its effectiveness through a real-world data study in the population of the Basque Country (Spain). An observational real-world data design was used, with the target population being documented cases of osteoporotic fracture (humerus, hip, vertebra or wrist) in Osakidetza-the Basque Health Service between 1 January 2016 and 31 December 2023, in patients aged over 60 years, and the outcome of interest was a secondary fracture. Patients receiving pharmacological treatment (bisphosphonates, selective oestrogen receptor modulators, denosumab and/or anabolic agents) were compared with untreated patients using propensity score and survival analysis (Kaplan-Meier curves and Cox regression). The total target population analysed was 56,218 cases of first fracture, of which 22,649 were hip, 8150 were humerus, 12,833 were wrist and 12,586 were vertebral fractures. Treatment coverage was low (20.00%). Treatment was effective overall for all fractures, with a hazard ratio (HR) of 0.902 (confidence intervals [CIs] 0.881-0.924), and for first fractures of the humerus (HR: 0.698; CI: 0.643-0.758), vertebra (HR: 0.819; CI: 0.785-0.855) and wrist (HR: 0.765; CI: 0.726-0.806), but not for hip fractures (HR:1.113; CI: 1.070-1.158). Fracture prevention was effective in reducing the risk of a second fracture. Notable differences were observed by first fracture type, treatment being ineffective for hip fractures. Furthermore, treatment coverage must be increased in order to reap the full benefits of secondary prevention at a population level.
Stroke and systemic embolism are recognized but poorly characterized complications of atrial fibrillation (AF) and left atrial flutter (AFL) catheter ablation. Their incidence, outcomes, and procedural associations remain insufficiently defined. Retrospective global registry was initiated by the European Heart Rhythm Association Scientific Committee. A secure database captured data from ablation centres worldwide on general AF and left AFL ablation activity, as well as detailed information on patients with symptomatic embolic events between 2017 and 2024. Overall, 204 centres reported 335 743 ablation procedures and 550 embolic events (incidence 0.16%). Centre-level rate ranged from 0% to 3.1%. Most events were cerebral (94%), followed by peripheral (5%), and combined (1%). Coronary air embolism accounted for 62% of all peripheral events. Intraprocedural events occurred in 93 patients (17%), within 72 h in 357 (78%) and beyond 72 h in 100 (22%); 128 cases (23%) were diagnosed after hospital discharge. Nonparoxysmal AF (0.23% vs 0.15%; P < .001), centre experience, and ablation energy source (radiofrequency, 0.16%; cryoballoon, 0.16%; pulsed field ablation, 0.25%; laserballoon, 0.88%; P < .001) were associated with embolic risk. Median NIHSS score after stroke was 4 (interquartile range, 2-9). Three-month follow-up was available for 518 patients with embolism (95%): 181 (35%) had sequelae and 16 (3%) died. Symptomatic embolic events are infrequent but associated with significant morbidity and mortality. Most events occur early, though a substantial proportion arise later. Higher event rates were observed with laser and possibly with pulsed field ablation. A greater centre experience was associated with a lower embolism incidence.
Cardiac resynchronization therapy (CRT) is an established treatment for selected patients with heart failure (HF), yet its role in advanced age remains insufficiently defined. Adults aged ≥ 80 years are markedly underrepresented in randomised trials, frequently present with multimorbidity and frailty, and often develop HF related to pacing-related mechanisms, including pacing-induced cardiomyopathy (with LVEF decline) and pacing-related dyssynchrony that is not fully addressed by guideline-based algorithms. In this context, CRT implantation or upgrade represents a complex cardiogeriatric decision rather than a purely electrophysiological intervention. This narrative review examines the physiological rationale, available evidence, and clinical challenges of CRT in advanced-age populations, illustrated by a representative clinical vignette of pacemaker-induced HF. We discuss age-related myocardial vulnerability, secondary mitral regurgitation, competing mortality risks, and the predominance of functional and quality-of-life outcomes over survival endpoints. Particular emphasis is placed on integrating geriatric domains—frailty, functional status, cognition, and proportionality of care—into CRT decision-making. We explicitly distinguish pacing-induced cardiomyopathy (with reduced LVEF) from isolated pacing-related dyssynchrony; in patients with preserved LVEF, congestion is more often driven by a severe haemodynamic substrate—particularly valve dysfunction—than by dyssynchrony alone. In selected older adults, CRT may provide meaningful symptomatic and functional benefit when HF is driven by potentially reversible dyssynchrony, even if survival gains are limited. A cardiogeriatric, physiology-based approach may help identify patients most likely to benefit from CRT while avoiding disproportionate interventions in individuals with advanced frailty or limited physiological reserve.
BackgroundThe aging of the population is leading to an increase in the incidence of neurocognitive disorders, particularly Alzheimer's disease, which has become a significant public health priority. Given the importance of early intervention in neurocognitive disorders, the identification of objectively defined subtle cognitive decline (Obj-SCD) may lead to early identification and better odds of slowing disease progression.ObjectiveTo characterize the connectivity patterns of subjects with Obj-SCD.MethodsFifty-one healthy adults (21 with Obj-SCD and 30 controls) over 55 years old underwent functional MRI and neuropsychological evaluations. MRI scans were conducted using a 3.0 Tesla scanner, and the data were preprocessed and denoised with CONN and SPM software, followed by independent component analysis (ICA) for identifying 20 brain networks and region-of-interest (ROI) analyses for assessing functional connectivity. The thresholds for the results were p < 0.05 for connections and FDR-corrected p < 0.05 for clusters.ResultsCompared with controls, individuals with Obj-SCD exhibited both hyperconnectivity and hypoconnectivity across key brain networks; increased activity was observed in the left angular and right lingual gyri, which showed greater connectivity with the language and visual networks but reduced connectivity with the somatosensory and dorsal attention networks. The default mode and central executive networks also showed functional connectivity alterations, whereas the salience network exhibited hypoconnectivity.ConclusionsThe connectivity alterations of individuals with Obj-SCD may reflect compensatory mechanisms, early network disruptions, or both. fMRI-based analyses could aid in detecting these early changes, providing opportunities for interventions that may slow or prevent further cognitive decline.
Water quality modelling offers the opportunity of estimating the magnitude of pathogen loads into wastewater by using data on disease prevalence and excretion. The objective of this paper is to reflect on the potential of using prevalence and excretion rate data from the literature to simulate wastewater concentrations for norovirus and rotavirus. Three systematic literature reviews were carried out to collect worldwide data. Firstly, targeting community-level prevalence data, secondly, viral excretion rates in faecal material, and thirdly, concentrations in wastewater. Data collected in the first two reviews were input to simulate concentrations in wastewater. Model results were compared with reported concentrations collected in the latest review. Of 2,193 studies, 97 were included. Reported community-level prevalence of infection ranged from 0.22 to 9.5% for norovirus and 0 to 3.3% for rotavirus. Mean viral excretion was 4.9 × 1010 and 9.7 × 108 GC/g stool for norovirus and rotavirus, respectively. Average reported wastewater concentrations were 1.5 × 107 and 2.4 × 107 GC/100 mL, respectively. Modelled concentrations were generally higher than observed values. This synthesis demonstrates the potential of integrating prevalence and excretion data through modelling to estimate pathogen loads in wastewater while highlighting major sources of variability and the need for more data collection on prevalence and excretion.
Psychosocial well-being relates to lower cardiovascular risk, and a healthy lifestyle may contribute to this association. Prior research has focused on aging adults, although health behaviors are usually consolidated in early adulthood. This longitudinal study assessed the association between two psychosocial well-being indicators and subsequent healthy lifestyles in young adults. Participants (n = 799; agemean = 30.6 years) in the Nicotine Dependence in Teens Study completed items to derive the emotional vitality score, a flourishing scale, and covariates in 2017-2020. Data on selected outcomes (i.e., smoking, sleep, physical activity, alcohol intake, diet quality), collected in 2017-2020 and 2020-2021, were combined into a lifestyle score used categorically (≥ 4 healthy behaviors) and continuously (0-5 scores). Associations between psychosocial well-being indicators and lifestyle up to 4 years later were modeled using logistic and linear regressions. In model 3 adjusting for sociodemographic, health-related, and depression covariates, higher likelihood of a healthy lifestyle (≥ 4 healthy behaviors) was observed with flourishing (OR = 1.56, 95%CI = 1.02-2.40), but the CI for emotional vitality included the null (OR = 1.62, 95%CI = 0.93-2.81). Both well-being indicators were similarly associated with continuous lifestyle scores (e.g., model 3, per 1-SD unit: βflourishing = 0.13, 95%CI = 0.06-0.21; βemotional vitality = 0.10, 95%CI = 0.02-0.17). Further controlling for baseline lifestyle attenuated associations (model 4; βflourishing = 0.10, 95%CI = 0.03-0.18; βemotional vitality = 0.06, 95%CI = -0.02 to 0.14). When assessing behaviors separately, both well-being indicators were associated with healthy diets and sleep only. Flourishing and emotional vitality may promote healthy behaviors among young adults and be considered in prevention strategies aiming to foster healthy lifestyles in this age group.
To compare the use of healthcare resources among the Gipuzkoa population with and without dementia. A retrospective, cross-sectional cost study was conducted on the entire population over 60 years of age registered with the Basque Health Service. We measured the use of health services (hospital and primary care) and health needs as a function of the presence of dementia and neuropsychiatric symptoms, adjusting for age, sex and comorbidity. Generalised linear models from the Tweedie family distribution were fitted, taking into account the asymmetric distribution of costs. Of the 215,859 over-60-year-olds in Gipuzkoa registered, 7553 (3.5%) had dementia. The median (interquartile range) cost was €743 (241-1682) for the total population, broken down into €722 (241-1660) for individuals without dementia and €1090 (481-2140) for those with dementia. In the Tweedie models adjusted for need, the estimated costs were €496 for the group with only neuropsychiatric symptoms, compared to €358 for the group with both conditions. When healthcare resource use is adjusted for need, people with dementia receive less care than those without. However, it is difficult to determine whether this is harmful, depriving people with dementia of necessary care (inverse care law), or beneficial, sparing them from unnecessary treatment (overuse). .
An integrated study was conducted to evaluate quality loss in small marine fish-sardine (Sardina pilchardus), horse mackerel (Trachurus trachurus), and megrim (Lepidorhombus whiffiagonis)-during a 9-day chilled storage. A progressive increase in microbial counts was observed in all species; aerobic mesophiles exceeded the spoilage limit (7 log CFU·g-1) only in horse mackerel by day 9 (7.02 log CFU·g-1), while remaining below this threshold in sardine (4.49 log CFU·g-1) and megrim (5.42 log CFU·g-1). Lipid oxidation showed species-specific behaviour, with sardine and horse mackerel exhibiting higher peroxide values (up to 19.73 and 10.73 meq O2·kg-1 lipids, respectively) and TBARS formation, whereas megrim showed limited primary and secondary oxidation but a marked increase in tertiary products (ca. six-fold). Lipid hydrolysis increased significantly, with free fatty acids rising by factors of approximately 4.1 (sardine), 13.7 (horse mackerel), and 18.6 (megrim). Similarly, trimethylamine formation increased markedly, with values rising by factors of about 13.1, 19.0, and 51.8, respectively. Sensory evaluation indicated that all species remained acceptable up to day 6 but were unacceptable by day 9, establishing a shelf life of approximately 6 days. Overall, horse mackerel showed the fastest deterioration, highlighting the need for species-specific shelf life assessment strategies.
To evaluate the prognostic value of the C-reactive protein/albumin (CAR) for mortality in older adults with sepsis. Prospective observational cohort study conducted at General Hospital Zone No. 21, León, Guanajuato, Mexico (Nov 2023-Aug 2025). Consecutive patients aged >60 years with Sepsis-3-defined sepsis or septic shock, excluding those with prior ICU care, transfers, malignancies, cirrhosis, autoimmune disease, or non-septic shock. None. The CAR and Sequential Organ Failure Assessment (SOFA) scores were measured at diagnosis and 72 h. 28-day all-cause mortality, with predictive performance assessed via area under the ROC curve (AUC). CAR was higher in septic shock versus sepsis. In patients with sepsis, both initial (AUC = 0.867) and 72-h (AUC = 0.852) ratios predicted mortality better than SOFA (AUC = 0.786). In septic shock, SOFA was superior (AUC = 0.785 vs. 0.637). An initial ratio in the highest tertile independently predicted mortality (HR 2.88, 95% CI 1.15-5.19, p < 0.001). The CAR is a strong, independent mortality predictor in older adults with sepsis, outperforming SOFA in sepsis but not in septic shock. This simple biomarker can aid early identification of high-risk patients to guide timely intervention.
Type IV pili (T4P) mediate surface motility, host interactions, and DNA uptake through cycles of extension and retraction. While the primary retraction ATPase PilT has been extensively characterized, its homolog PilU remains less well understood despite being demonstrated as a PilT-dependent retraction ATPase. Here, we determined six PilU structures by cryo-electron microscopy and x-ray crystallography. The structures reveal a homohexameric assembly stabilized by interactions between the C-terminal catalytic domain of one subunit and the N-terminal PAS-like domain of a neighboring subunit. PilU adopts multiple conformational states, exhibiting different combinations of open and closed interfaces even in the absence of nucleotide. Comparison with PilT highlights structural features that likely underlie PilU's weak ATPase activity and its dependence on PilT for function. Together, these findings provide a structural framework for understanding PilU's role within the T4P retraction machinery.
Very old adults with heart failure (HF) experience high rehospitalisation rates related to multimorbidity, functional vulnerability, and complex care transitions. Empirical evidence on factors associated with rehospitalisation in very old adults with HF managed within integrated post-discharge care pathways remains limited. This study aimed to describe rehospitalisation patterns and associated clinical markers in very old patients with HF managed within an integrated cardiogeriatric post-discharge pathway. This retrospective single-centre cohort included patients aged ≥65 years hospitalised for acute HF and enrolled at discharge in an integrated cardiogeriatric pathway combining structured remote monitoring, rapid-access day-hospital services and coordinated outpatient follow-up (April 2023-August 2025). Analyses were restricted to patients who survived the early post-discharge period and had available 12-month follow-up data, in order to assess rehospitalisation status at predefined post-discharge time points. The primary outcome was unplanned HF rehospitalisation at 12 months; secondary outcomes included rehospitalisation at 3 and 6 months, predictors of rehospitalisation and hospital length of stay. Exploratory multivariable logistic regression analyses were performed. Among 255 very old patients with available 12-month follow-up data (median age 87 years), rehospitalisation rates were 9.8% at 3 months, 16.1% at 6 months and 24.7% at 12 months. Higher loop diuretic dose was associated with rehospitalisation at 3 months. At 6 months, moderate-to-severe mitral regurgitation, higher diuretic dose and absolute iron deficiency were independently associated with rehospitalisation. At 12 months, moderate-to-severe mitral regurgitation, iron deficiency and chronic obstructive pulmonary disease were independently associated. These findings apply to patients who survived the early post-discharge period and had sufficient follow-up data, rather than to an unselected acute HF population. In very old patients with HF and available longitudinal follow-up, higher loop diuretic dose, iron deficiency, moderate-to-severe mitral regurgitation, and COPD were associated with rehospitalisation status at predefined time horizons. These exploratory findings suggest that routinely available clinical markers may help support risk-stratified follow-up in advanced-age HF populations.
BackgroundHeart rate variability (HRV) is related to cognitive functioning and may serve as an early Alzheimer's disease biomarker.ObjectiveWe examine whether HRV predicts cognitive and pathophysiological brain markers assessed eight and thirteen years later, independently of coronary calcification.Methods269 cognitively unimpaired adults were selected based on their coronary artery calcification score (absent, score=0; high, score≥300), obtained from cardiac computed tomography scans (T2, 2017-2022). HRV in the time domain (root mean square of successive RR interval differences), measured at T0 (2007-2013), T1 (2014-2017), and the change between T0 and T1, was the predictor. Outcomes included cognitive measures, serum Alzheimer's disease biomarkers, and brain imaging markers obtained at T3 (2022-2023). Linear regression models were run, stratified by coronary calcification groups and adjusted for demographics, lifestyle and cardiometabolic factors.ResultsParticipants with high T2 calcification showed lower HRV at T0 and a positive change compared to those with absent calcification. In participants with high T2 calcification, higher HRV at T0 was associated with lower Aβ42/Aβ40 at T3, while associations with all other markers were not significant. HRV at T1 and the change were not associated with any of the outcomes.ConclusionsHRV was not associated with cognitive and brain imaging outcomes. In participants with high calcification, higher HRV measured thirteen-year earlier, typically a marker of a healthier state, was associated with a lower Aβ42/Aβ40 ratio, typically linked to Alzheimer's disease. Findings underscore the need to consider coronary calcification in research of HRV as a marker of cognitive decline.
The alterations in neuropsychological performance described in Obsessive-Compulsive Disorder (OCD) reflect dysfunctions of the neurobiological structures underlying the disorder. Cognitive functions are influenced by clinical variables and are considered a potential endophenotype of the disorder. Although OCD is a chronic illness, data regarding the course of cognitive impairment are scarce. The present study assessed 60 OCD patients and 30 healthy controls (HC). Both groups were followed for a period of 10.6 years (range 5-18 years). Neuropsychological performance was assessed with a battery measuring executive subcomponents and non-verbal memory at baseline and after follow-up, using repeated-measures mixed models. Several clinical variables were also assessed in the patient group. At baseline, patients with OCD demonstrated significantly poorer performance on neuropsychological tests than HC. Overall, the patterns of specific executive processes (organizational strategies and working memory) and non-verbal memory remained unchanged during the follow-up period in both groups. A reduction in severity of depression and obsessive-compulsive symptomatology was observed at the end of follow-up in OCD patients. In the sample, female sex was associated with worse performance on certain executive functions, and age with greater impairment in non-verbal memory after a decade of follow-up. OCD patients showed significant impairments on neuropsychological tests compared to HC at baseline. After follow-up, both groups showed a similar decline in neuropsychological performance, with no significant differences. These findings suggest that cognitive deficits in OCD remain stable over time and may reflect trait-like characteristics, and that sex may differentially affect cognitive performance with aging.
The survival advantage of HER2-positive breast cancer from targeted treatment is commonly undermined by catastrophic health expenditure (CHE), particularly in resource-limited areas. Recognizing that financial catastrophe leads to non-adherence to treatment and dissaving practices, we examined the out-of-pocket (OOP) expenses of patients with HER2-positive breast cancer. The study aimed to estimate the median total per-cycle out-of-pocket expenditure of HER2-positive breast cancer treatment from the patient perspective, in public and private clinics, evaluate the association of catastrophic health expenditure with non-adherence to treatment, and describe dissaving practices. This was a cross-sectional micro-costing analysis of the treatment of HER2-positive breast cancer from the patient perspective from a tertiary cancer center and select private clinics in the Philippines. Random sampling of patients with HER2-positive breast cancer was done. Using a validated questionnaire, a guided interview was administered. Catastrophic health expenditure was estimated as having OOP of >20% of the household income. OOP costs were assessed retrospectively from the time of confirmed HER2 diagnosis up to the date of survey, while household income referred to the corresponding period. The proportion of patients experiencing catastrophic health expenditure was computed. Fisher's exact was used to assess for any association between CHE and non-adherence to treatment. Descriptive statistics were used to report dissaving practices. All statistical analyses were performed using Stata analytical software version 12. A total of 101 patients participated in the study. The mean age of participants from the tertiary cancer center and private clinics were 52 and 58 years old respectively. Patients from the private clinics had a median total OOP expenditure of PhP 54,737.06 (IQR = PhP 102,670.00), compared with patients from tertiary cancer center who had a median total OOP expenditure of PhP 13,920.66 (IQR = PhP 20,830.00). The overall prevalence of CHE (90.9%, 95% CI 0.81, 0.95) and nonadherence to treatment with trastuzumab (79%, 95% CI 0.70, 0.87) were high, and similar in both groups. A number of dissaving practices such as resignation from work, borrowing money from friends, selling assets were observed. The high rate of CHE and treatment delay among patients with HER2-positive breast cancer were not addressed by the existing cancer programs. Most OOP expenditure was for trastuzumab. Current cancer support programs have potential to address the financial impact of their treatment.
Sexual violence in armed conflict contexts constitutes a serious violation of human rights and a persistent challenge for global public health. This article analyzes the differentiated impacts on the physical, mental, sexual, and reproductive health of women and girls, from a public health perspective with a gender approach. Through a narrative review of academic literature, institutional reports, and international legal frameworks, two main mechanisms of harm were identified: 1) the use of gender-based violence as a war tactic, and 2) the disruption of essential health and social protection services. The analysis reveals long-term psychosocial consequences, increased maternal morbidity and mortality, neglect of menstrual health, and the structural impact of forced displacement and the feminization of poverty. Institutional barriers are examined, such as the lack of disaggregated data, legal impunity, and the exclusion of women from decision-making spaces. Positive experiences in transitional justice mechanisms and women-led initiatives are also highlighted, offering effective pathways for prevention, care, and reparation. The article offers public policy recommendations for humanitarian actors and health systems: comprehensive implementation of sexual and reproductive health services in emergencies, gender-sensitive mental health support, information systems with an intersectional perspective, and active participation of women in all phases of post-conflict response and reconstruction.
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.