Knowledge Gaps in Cardiovascular Care of the Older Adult Population. A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society

Michael W. Rich, Deborah Chyun, Adam H. Skolnick, Karen P. Alexander, Daniel E. Forman, Dalane W. Kitzman, Mathew S. Maurer, James B. McClurken, Barbara M. Resnick, Win K. Shen, David L. Tirschwell

Research output: Contribution to journalArticle

Abstract

The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults ≥75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged ≥75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older patients typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision making, and recommend future research to close existing knowledge gaps. To achieve these objectives, we conducted a detailed review of current American College of Cardiology/American Heart Association and American Stroke Association guidelines to identify content and recommendations that explicitly targeted older patients. We found that there is a pervasive lack of evidence to guide clinical decision making in older patients with cardiovascular disease, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older patients representative of those seen in clinical practice and that incorporate relevant outcomes important to older patients in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older patients, thereby enhancing patient-centered evidence-based care of older people with cardiovascular disease in the United States and around the world.

Original languageEnglish (US)
JournalJournal of the American College of Cardiology
DOIs
StateAccepted/In press - 2016

Fingerprint

Population
Cardiovascular Diseases
Guidelines
Assisted Living Facilities
Quality of Life
Patient Advocacy
Nursing Homes
Comorbidity
Cause of Death
Decision Making
Maintenance
Clinical Trials
Morbidity
Mortality
Incidence
Therapeutics

Keywords

  • ACC Scientific Statements
  • Elderly
  • Heart failure
  • Heart rhythm disorders
  • Non-cardiac surgery
  • Stroke
  • Valvular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Knowledge Gaps in Cardiovascular Care of the Older Adult Population. A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society. / Rich, Michael W.; Chyun, Deborah; Skolnick, Adam H.; Alexander, Karen P.; Forman, Daniel E.; Kitzman, Dalane W.; Maurer, Mathew S.; McClurken, James B.; Resnick, Barbara M.; Shen, Win K.; Tirschwell, David L.

In: Journal of the American College of Cardiology, 2016.

Research output: Contribution to journalArticle

Rich, Michael W. ; Chyun, Deborah ; Skolnick, Adam H. ; Alexander, Karen P. ; Forman, Daniel E. ; Kitzman, Dalane W. ; Maurer, Mathew S. ; McClurken, James B. ; Resnick, Barbara M. ; Shen, Win K. ; Tirschwell, David L. / Knowledge Gaps in Cardiovascular Care of the Older Adult Population. A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society. In: Journal of the American College of Cardiology. 2016.
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