Prioritizing Functional Capacity as a Principal End Point for Therapies Oriented to Older Adults With Cardiovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association.
Adults are living longer, and cardiovascular disease is endemic in the growing population of older adults who are surviving into old age. Functional capacity is a key metric in this population, both for the perspective it provides on aggregate health and as a vital goal of care. Whereas cardiorespiratory function has long been applied by cardiologists as a measure of function that depended primarily on cardiac physiology, multiple other factors also contribute, usually with increasing bearing as age advances. Comorbidity, inflammation, mitochondrial metabolism, cognition, balance, and sleep are among the constellation of factors that bear on cardiorespiratory function and that become intricately entwined with cardiovascular health in old age. This statement reviews the essential physiology underlying functional capacity on systemic, organ, and cellular levels, as well as critical clinical skills to measure multiple realms of function (eg, aerobic, strength, balance, and even cognition) that are particularly relevant for older patients. Clinical therapeutic perspectives and patient perspectives are enumerated to clarify challenges and opportunities across the caregiving spectrum, including patients who are hospitalized, those managed in routine office settings, and those in skilled nursing facilities. Overall, this scientific statement provides practical recommendations and vital conceptual insights.
Daniel E
DE
Forman
Ross
R
Arena
Rebecca
R
Boxer
Mary A
MA
Dolansky
Janice J
JJ
Eng
Jerome L
JL
Fleg
Mark
M
Haykowsky
Arshad
A
Jahangir
Leonard A
LA
Kaminsky
Dalane W
DW
Kitzman
Eldrin F
EF
Lewis
Jonathan
J
Myers
Gordon R
GR
Reeves
Win-Kuang
WK
Shen
D000572:American Heart Association; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002320:Cardiovascular Physiological Phenomena / Q000235:genetics*; D006801:Humans; D012307:Risk Factors; D014481:United States
AHA Scientific Statements; aged; cardiopulmonary exercise test; cardiorespiratory fitness; exercise tolerance; frail older adults; physical activity; sarcopenia