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AGS/AHA/ACC Release Statement on Cardiovascular Care for OAs
Due to critical gaps in knowledge, an executive statement by the American Heart Association (AHA), American College of Cardiology (ACC), and American Geriatrics Society was recently released, summarizing the current cardiovascular care guideline recommendations as they apply specifically to older adults (J Amer Geriatr Soc. 2016;64[11]:2185-2192).
Cardiovascular disease (CVD) is the leading cause of death and major disability in adults aged 75 and older; yet, the effect of CVD on quality of life, morbidity, and mortality in older adults, has 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.
To address this problem, investigators conducted a detailed review of current 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.
A summary of the full recommendations were provided in an article online (full recommendations can be accessed below) and addressed the following situations:
- Stable ischemic heart disease
- Cerebrovascular disease and stroke
- Perioperative management for noncardiac surgery
- Heart rhythm disorders
- Valvular heart disease
- Heart failure
- Peripheral arterial disease
- Acute coronary syndromes
Authors also made recommendations on how to close current knowledge gaps across guidelines. Some of their suggestions include mandatory reporting of enrollment, assistance with transportation, and other challenges limiting inclusion of older adults; studies that include the full spectrum of community-dwelling and institutionalized older adults; studies that incorporate health status, quality of life, functional capacity, maintenance of independence, and cognitive function into study design; studies that assess cost effectiveness, value, and resource use in the diagnosis and treatment of older adults with or at risk of CVD and with reference to specific person-centered clinical outcomes.
Overall, the investigators concluded, there is a critical need for large population-based studies, examination of registries (eg, National Cardiovascular Data Registry, AHA Stroke Registry) and existing databases (eg, Medicare and Veterans Affairs databases), interrogation of “big data” derived from electronic health records, and clinical trials using novel study designs that incorporate person-centered outcomes relevant to older adults and, most importantly, include a broad mix of older adults typical of those seen in clinical practice.
The results of these studies will enable translation of important findings into future evidence-based guidelines, transforming care and enhancing outcomes for the growing population of older individuals with CVD in the United States and around the world.—Amanda Del Signore
