We read with great interest the excellent consensus document of the Spanish Society of Cardiology on teleconsultations for clinical cardiologists in the era of COVID-19 by Barrios et al.1 Telematic cardiology consultations are now a reality in Spain2 and a document to help organize them will always be welcome. However, as active members of the Geriatric Cardiology Section, we were disappointed to see that there was no specific reference to elderly patients, who make up a very high percentage of the patients we see in our everyday practice. Elderly patients, who are particularly vulnerable to coronavirus infection,3 need more help to understand that telemedicine can be an effective way to communicate with their cardiologists and to be able to use it effectively. With this in mind, the 5M framework4,5 (figure 1) can be a useful guide for teleconsultations:
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Most important: ask the patient about their objectives, preferences, and priorities. This is an excellent way to establish a good relationship at the beginning of a teleconsultation.
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Medications: checking which medications the patient is taking is straightforward in most of the autonomous communities in Spain due to the electronic prescribing system. It is important to check how patients take their medication and if they know what it is for, as well as to assess possible withdrawal of unnecessary drugs.
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Mental: it is essential to address the patient's cognition in each consultation. A brief evaluation of possible cognitive decline will help to ensure that any discussion is understood and remembered. Assessment of orientation to time and place and cognitive status can be performed quickly and easily with questions such as: “What day of the week is it?” or “Can you tell me the months of the year backwards, starting with December?”
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Mobility: basic mobility can be assessed during a teleconsultation by enquiring about the patient's ability to get up from a chair and walk. Recent changes in mobility can also be assessed by comparing their current and previous status.6
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Morbidity: it is essential to consider the other conditions that may be present in our patients, often with a marked effect on prognosis, and that these can also cause symptoms that may be confused with those of some cardiac processes.
During this time of pandemic when older patients are suffering the stress of a public health crisis compounded by the need to adapt to newer technologies, any action that can help make teleconsultations safer, easier, and more person-centered are welcomed. The 5-M framework is a simple way to personalize telemedicine and support our older patients.
