Risk Stratification in Elderly Coronary Artery Disease Patients: Can We Predict Which Seniors Benefit Most from Revascularization Options?

McClurken, James B.; Rosenhek, Raphaël; Guy, T. Sloane; Forman, Daniel E.

doi:10.1007/s12170-011-0195-z

Cited by 3 publications

(1 citation statement)

References 64 publications

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“…35 • Studies are needed concerning how best to assess and incorporate advance care planning into the decision-making process before a major intervention is undertaken and whether early consideration of goals of care influences choice of therapy. *…”

Section: Recommendations To Close Knowledge Gapsmentioning

confidence: 99%

Knowledge Gaps in Cardiovascular Care of the Older Adult Population

Rich¹,

Chyun²,

Skolnick³

et al. 2016

Circulation

Self Cite

157

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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 ofCirculation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0000000000000380The American Heart Association, the American College of Cardiology, and the American Geriatrics Society make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Copies: This document is available on the World Wide Web sites of the American Heart Association (professional.heart.org) and the American College of Cardiology (www.acc.org). A copy of the document is available at http://professional.heart.org/statements by using either "Search for Guidelines & Statements" or the "Browse by Topic" area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Expert peer ...

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Section: Recommendations To Close Knowledge Gapsmentioning

confidence: 99%

Knowledge Gaps in Cardiovascular Care of the Older Adult Population

Rich¹,

Chyun²,

Skolnick³

et al. 2016

Circulation

Self Cite

157

View full text Add to dashboard Cite

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Risk Stratification for Older Adults with Myocardial Infarction

Saraf

Bell

2016

Curr Cardiovasc Risk Rep

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Knowledge Gaps in Cardiovascular Care of the Older Adult Population

Rich¹,

Chyun²,

Skolnick³

et al. 2016

Journal of the American College of Cardiology

194

View full text Add to dashboard Cite

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.

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Risk Stratification in Elderly Coronary Artery Disease Patients: Can We Predict Which Seniors Benefit Most from Revascularization Options?

Cited by 3 publications

References 64 publications

Knowledge Gaps in Cardiovascular Care of the Older Adult Population

Knowledge Gaps in Cardiovascular Care of the Older Adult Population

Risk Stratification for Older Adults with Myocardial Infarction

Knowledge Gaps in Cardiovascular Care of the Older Adult Population

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