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AHA: Preventive care for elderly patients should be personalized
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Strategies to prevent major cardiac events in adults aged at least 75 years should be individualized and the patient should play a role in choosing therapy, according to a new scientific statement from the American Heart Association.
The statement, written by a group chaired by Jerome L. Fleg, MD, and Daniel E. Forman, MD, covers medical and lifestyle intervention for CVD patients aged at least 75 years. Topics addressed include obesity, high BP, cholesterol, diabetes, inadequate nutrition, physical inactivity, cardiac rehabilitation, revascularization techniques and implantable cardioverter defibrillators.
“Preventive care should not be set aside simply because you’re getting older,” Forman, director of cardiac rehabilitation at Brigham and Women’s Hospital, said in a press release. “Care for older adults demands equally rigorous thought as for a younger adult.”
Physicians must balance the benefits of secondary atherosclerotic CVD prevention with the risks that some strategies may carry for older adults, according to the statement.
“Secondary prevention goals in older patients with [atherosclerotic CVD] must also incorporate consideration of the greater iatrogenic risks of the therapies themselves in older adults,” the group wrote. “Comorbidities, polypharmacy, socioeconomic stresses and cognitive limitations frequently confound secondary prevention considerations. Thus, instruments to better delineate the relative risks and benefits of specific therapies in older patients are needed.”
The panel called for more research “to clarify which senior patients with [atherosclerotic CVD] are likely to derive the most benefit from secondary prevention therapy.” Likewise, it called for more research “to clarify the medication regimens, lifestyle modifications and revascularization/ICD strategies that yield the greatest benefit/risk in this rapidly expanding age group.” Elderly patients should be included in pertinent clinical trials and registry studies, panel members wrote.
The panel also called for better health literacy among seniors and their family members, and emphasized that physicians should ascertain whether the use of a secondary prevention measure “is consistent with each older patient’s goals and perceived [quality of life].”
Specific recommendations for doctors include:
- Carefully evaluate patient preferences because some may prefer to live with increased risk for CV events rather than make a lifestyle change or undergo a procedure.
- Ask patients if they are using alternative medicine products because they may interact with prescription drugs.
- Consider issues such as drug interaction, adherence and medication costs for patients with multiple medications.
- Consider benefits of prevention measures beyond survival gains.
Disclosure: See the full statement for a list of the writing group members’ relevant financial disclosures.
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