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Scientific statement addresses knowledge gaps in CV care of older adults
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In a recent scientific statement, the American Heart Association, the American College of Cardiology and the American Geriatrics Society called for a multitude of large population-based studies and clinical trials to address knowledge gaps in CV care of older adults.
“Despite the high prevalence, morbidity and mortality of CVD in older adults, most randomized clinical trials have either explicitly excluded older adults or have enrolled only relatively healthy older patients with few comorbidities or functional impairments,” Michael W. Rich, MD, FAHA, FACC, professor of medicine at Washington University School of Medicine, St. Louis, and chair of the advisory committee, and colleagues wrote. “As a result, the generalizability of the results of most major clinical trials to older patients, especially those older than 75 years of age with multi-morbidity, is uncertain.”
A review of current ACC/AHA and American Stroke Association guidelines revealed a few common themes, the authors wrote. First, the studies on which the guidelines are based have few older adults, particularly older patients with multiple comorbidities, enrolled. Second, frailty, cognitive function and patient preference should be taken into consideration when making treatment decisions.
Rich and colleagues offered several recommendations to close the knowledge gap across the guidelines.
According to the statement, better efforts are needed in the recruitment of older adults for clinical CV research, including mandatory reporting of enrollment, assistance with transportation and other challenges older adults might face, as well as postmarketing surveillance. A special focus also should be made to recruit older adults with multiple comorbidities, functional and cognitive deficits, and frailty.
Future studies, Rich and colleagues wrote, also should incorporate quality of life, functional capacity, maintenance of independence and cognitive function in the outcomes. Patient preference and values also should be factors in the decision-making process for CVD management. In addition, instead of an emphasis on pharmacological and surgical or catheter-based interventions, the committee recommended that attention also be given to nonpharmacological interventions such as diet and exercise.
Another recommendation was for the further study of patient-centered BP, lipid and diabetes goals, as well as optimal fitness targets for older adults.
“To overcome these deficiencies, there is a critical need for a multitude of large population-based studies and clinical trials using novel study designs that incorporate patient-centered outcomes relevant to older patients and, most importantly, that include a broad mix of older patients typical of those seen in clinical practice,” the committee concluded. – by Tracey Romero
Disclosure: Rich reports no relevant financial disclosures. Please see the full statement for a list of all other authors’ relevant financial disclosures.
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