ACC/SGC release curriculum initiative focusing on geriatric cardiology

Future increases in the number of older patients prompted combined action from the two organizations.

Issue: December 2007

The American College of Cardiology and the Society for Geriatric Cardiology have developed a new training curriculum aimed at increasing awareness and quality of cardiovascular care for older adults.

The curriculum is composed of six educational modules addressing a variety of issues specific to older patients: cardiovascular aging physiology, geriatric cardiovascular syndromes, geriatric pharmacology, general geriatric syndromes, coronary and valvular diseases in older adults, and HF and arrhythmias in older adults. The initiative, enabled with a $300,000 grant from the John A. Hartford Foundation, will be implemented in fellowship training programs with plans to expand its scope.

“It’s so important for us to know about the special aspects of taking care of older people with cardiovascular disease,” Jeanne Wei, MD, PhD, professor of medicine at the University of Arkansas for Medical Sciences and president of the Society of Geriatric Cardiology, told Cardiology Today. “Because we cardiologists continue to be so successful in both primary and secondary prevention of CVD, our patients are going to be older because of this success. The cardiologists of both today and tomorrow need to be very aware of the specific nuances and special aspects of caring for older people with CVD.”

Health care crunch coming

With baby boomers nearing retirement, the number of Americans aged 65 and older is expected to grow to over 71 million, or approximately 20% of the U.S. population, by 2030, according to data in a CDC report. This increase in the number of patients utilizing health services and care will place a large burden on the health care system. According to information in the same report, health care costs are projected to rise by at least 25% by 2030 with the influx of older patients.

A shortage of cardiologists, particularly those who specialize in geriatric cardiology, is feared. According to the initiative’s directors, it is hoped that the new curriculum will help address some of these impending problems.

“I think there will be a limit in terms of people who are focusing on the specific management of patients with geriatric illnesses and the complexities of the illnesses that they have,” James Dove, MD, cardiologist with Prairie Cardiovascular Consultants and president of the American College of Cardiology, told Cardiology Today. “The important part of this initiative is that this is an area that is specialized in terms of cardiovascular medicine. We want to develop more information about how to care for these people properly and to answer the questions that we don’t have the answers to.”

Issues in older patients

The information cardiology fellows can gain from the curriculum will hopefully also increase understanding of data gathered through studies examining the complexities that older patients present. Complications involving competing medication regimens, for example, are frequently cited as a problem when treating older patients for cardiovascular problems.

“What I try to teach [cardiology fellows] to see is that there are significant changes that we really have to think about in older folks … you just can’t extrapolate what we already know,” Susan Zieman, MD, assistant professor of medicine at Johns Hopkins University and one of three principal investigator of the curriculum initiative, said in an interview. “Older folks are healthier than they were 20 years ago, but despite this, I think there is some bias in denying aggressive therapy. In general, we’re addressing that, but the goal is to determine what the optimal therapy really is so that we avoid some of the drug interactions and bad outcomes to which older patients are prone.”

Another problem for older patients is that they are difficult to study in the trial setting. Many older patients have trouble meeting inclusion criteria due to the complex and often compound nature of their conditions, which can make it difficult to extract useful and applicable data for the population.

“The truth is that the way we decide about drugs is through randomized clinical trials, and that is probably not going to be the way to study [drugs in] older people. Clinical trials are designed for a very homogeneous group of people … the heterogeneity of the older individuals really puts challenges to our current level of gaining evidence to take care of people,” Zieman said.

After initially being rolled out in fellowship training programs, the curriculum will be adjusted and implemented as needed. The initiative directors envision expanding the curriculum to upcoming meetings and to the internet. They want it to be a permanent presence at the Society of Geriatric Cardiology and the ACC. The curriculum will also receive a biannual review and update as information is gathered and obtained from the initiative.

“I think it’s a great initiative and is certainly needed,” Carl J. Pepine, MD, professor and chief of the division of cardiovascular medicine at the University of Florida, Gainesville, and chief medical editor of Cardiology Today, said in an interview. “We’re seeing huge numbers of patients in the geriatric age group. It sounds good, and this initiative seems to hit all of the key points.” – by Eric Raible

For more information:

To view the complete curriculum initiative, visit www.sgcard.org.
To view the 2007 State of Aging and Health in America Report, visit www.cdc.gov/aging/pdf/saha_2007.pdf.