Systematic review of clinical practice guidelines recommendations about primary cardiovascular disease prevention for older adults.
BACKGROUND
Clinical care for older adults is complex and represents a growing problem. They are a diverse patient group with varying needs, frequent presence of multiple comorbidities, and are more susceptible to treatment harms. Thus Clinical Practice Guidelines (CPGs) need to carefully consider older adults in order to guide clinicians. We reviewed CPG recommendations for primary cardiovascular disease (CVD) prevention and examined the extent to which CPGs address issues important for older people identified in the literature.


METHODS
We searched: 1) two systematic reviews on CPGs for CVD prevention and 2) the National CPG Clearinghouse, G-I-N International CPG Library and Trip databases for CPGs for CVD prevention, hypertension and cholesterol. We conducted our search between April and December 2013. We excluded CPGs for diabetes, chronic kidney disease, HIV, lifestyle, general screening/prevention, and pregnant or pediatric populations. Three authors independently screened citations for inclusion and extracted data. The primary outcomes were presence and extent of recommendations for older people including discussion of: (1) available evidence, (2) barriers to implementation of the CPG, and (3) tailoring management for this group.


RESULTS
We found 47 eligible CPGs. There was no mention of older people in 4 (9 %) of the CPGs. Benefits were discussed more frequently than harms. Twenty-three CPGs (49 %) discussed evidence about potential benefits and 18 (38 %) discussed potential harms of CVD prevention in older people. Most CPGs addressed one or more barriers to implementation, often as a short statement. Although 27 CPGs (58 %) mentioned tailoring management to the older patient context (e.g. comorbidities), concrete guidance was rare.


CONCLUSIONS
Although most CVD prevention CPGs mention the older population to some extent, the information provided is vague and very limited. Older adults represent a growing proportion of the population. Guideline developers must ensure they consider older patients' needs and provide appropriate advice to clinicians in order to support high quality care for this group. CPGs should at a minimum address the available evidence about CVD prevention for older people, and acknowledge the importance of patient involvement.
Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. jesse.jansen@sydney.edu.au.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. jesse.jansen@sydney.edu.au.
Jesse
J
Jansen
Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. shannon.mckinn@sydney.edu.au.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. shannon.mckinn@sydney.edu.au.
Shannon
S
McKinn
Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. carissa.bonner@sydney.edu.au.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. carissa.bonner@sydney.edu.au.
Carissa
C
Bonner
Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. les.irwig@sydney.edu.au.
Les
L
Irwig
Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. jdoust@bond.edu.au.|Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia. jdoust@bond.edu.au.
Jenny
J
Doust
Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. pglaszio@bond.edu.au.|Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia. pglaszio@bond.edu.au.
Paul
P
Glasziou
Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. brooke.nickel@sydney.edu.au.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. brooke.nickel@sydney.edu.au.
Brooke
B
Nickel
Academic Medical Centre, Department of Internal Medicine, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. b.c.vanmunster@amc.uva.nl.|Department of Geriatrics, Gelre Hospitaal, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, Netherlands. b.c.vanmunster@amc.uva.nl.
Barbara
B
van Munster
Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. kirsten.mccaffery@sydney.edu.au.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. kirsten.mccaffery@sydney.edu.au.
Kirsten
K
McCaffery
D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D006801:Humans; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000592:standards*