Knowledge Gaps in Cardiovascular Care of Older Adults: A Scientific Statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society: Executive Summary.
The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease (CVD) is the leading cause of death and major disability in adults aged 75 and older. Despite the effect of CVD on quality of life, morbidity, and mortality in older adults, individuals aged 75 and older have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older adults with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in nursing homes and assisted living facilities. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older adults 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, a detailed review was conducted of current American College of Cardiology/American Heart Association (ACC/AHA) and American Stroke Association (ASA) guidelines to identify content and recommendations that explicitly targeted older adults. A pervasive lack of evidence to guide clinical decision-making in older adults with CVD was found, as well as a paucity of data on the effect of diagnostic and therapeutic interventions on outcomes that are particularly important to older adults, 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 adults representative of those seen in clinical practice and that incorporate relevant outcomes important to older adults in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older adults and enhance person-centered care of older individuals with CVD in the United States and around the world.
School of Medicine, Washington University, St. Louis, Missouri.
Michael W
MW
Rich
College of Nursing, New York University, New York, New York.
Deborah A
DA
Chyun
Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York, New York.
Adam H
AH
Skolnick
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Karen P
KP
Alexander
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.|Department of Veterans Affairs, Geriatric, Research, Education, and Clinical Center, Pittsburgh, Pennsylvania.
Daniel E
DE
Forman
School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Dalane W
DW
Kitzman
Columbia University Medical Center, New York, New York.
Mathew S
MS
Maurer
RA Reif Heart Institute, Doylestown Hospital, Doylestown, Pennsylvania.|Temple University, Philadelphia, Pennsylvania.
James B
JB
McClurken
University of Maryland, Baltimore, Maryland.
Barbara M
BM
Resnick
Mayo Clinic Arizona, Phoenix, Arizona.
Win K
WK
Shen
University of Washington, Seattle, Washington.
David L
DL
Tirschwell
D000367:Age Factors; D000368:Aged; D000572:American Heart Association; D002309:Cardiology / Q000379:methods / Q000592:standards; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000628:therapy; D000066491:Clinical Decision-Making; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D005853:Geriatrics / Q000379:methods / Q000592:standards; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D014481:United States