There is a critical need for an increased number of large, population-based studies and clinical trials that include adults older than 75 years with complex comorbidities and other issues, according to a new scientific statement released by the ACC, in conjunction with the American Heart Association (AHA) and the American Geriatrics Society, and published in the Journal of the American College of Cardiology. The statement, which reviews the ACC, AHA, and American Stroke Association guidelines, contains detailed recommendations to close knowledge gaps in current guidelines for coronary artery disease, stable ischemic heart disease, percutaneous coronary intervention, and coronary artery bypass surgery, ventricular arrhythmias and sudden cardiac death, heart rhythm disorders, heart failure and more. Among the recommendations: • Increased efforts to recruit representative older adults in clinical cardiovascular research, including “mandatory reporting of enrollment, assistance with transportation and other challenges that limit the inclusion of older adults, and detailed post-marketing surveillance.” • Studies should include representation from both community-dwelling and institutionalized older adults, as well as include patients with multiple comorbid conditions, functional and cognitive deficits, and frailty. • Studies should incorporate assessment of health status, quality of life and functional capacity, as well as cost-effectiveness, value and resource utilization in the diagnosis and treatment of older adults with or at risk for cardiovascular disease. • Development of models for integration of patient preferences, values and goals of care into the decision-making process. “Such models should also involve caregivers and significant others and must anticipate and incorporate methods for overcoming impediments to decision making, such as cognitive impairment and sensory deficits.” The statement also notes that additional studies are needed to “delineate optimal strategies” for prevention of cardiovascular disease in older adults, including blood pressure, lipid and diabetes goals, “methodologies and targets for enhancing fitness, and novel approaches to primary and secondary prevention.” Studies evaluating the impact of rehabilitation services on clinical and functional outcomes are also urged. Mathew S. Maurer, MD, FACC, chair of ACC’s Geriatric Cardiology Section, underscores this message. “The aging of the population is having a profound impact on the practice of cardiology, which has become de facto geriatric cardiology,” he says. “This document highlights the knowledge gaps in our management of this critical segment of the population with cardiovascular disease and indicates there is much work ahead to address the deficiencies in our guideline-based recommendations.” According to Maurer, ACC’s Geriatric Cardiology Section is committed to addressing the issues identified in the statement by collaborating with other stakeholders including patients, their caregivers and providers in order to develop new paradigms of care. Learn more about the Geriatric Cardiology Section at ACC.org/Geriatric. Visit the Geriatric Cardiology Clinical Topic Collection on ACC.org for the latest clinical news, patient case quizzes and more.
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