Rich Michael W, Chyun Deborah A, Skolnick Adam H, Alexander Karen P, Forman Daniel E, Kitzman Dalane W, Maurer Mathew S, McClurken James B, Resnick Barbara M, Shen Win K, Tirschwell David L
School of Medicine, Washington University, St. Louis, Missouri.
College of Nursing, New York University, New York, New York.
J Am Geriatr Soc. 2016 Nov;64(11):2185-2192. doi: 10.1111/jgs.14576. Epub 2016 Sep 27.
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.
大多数心血管疾病的发病率和患病率随年龄增长而增加，心血管疾病（CVD）是75岁及以上成年人死亡和重度残疾的主要原因。尽管心血管疾病对老年人的生活质量、发病率和死亡率有影响，但在大多数主要的心血管试验中，75岁及以上的个体所占比例明显过低，而且几乎所有试验都排除了患有复杂合并症、有明显身体或认知残疾、身体虚弱或居住在疗养院和辅助生活设施中的老年人。因此，目前的指南无法为常规临床实践中常见的老年患者的诊断和治疗提供循证建议。本科学声明的目的是总结当前适用于老年人的指南建议，识别妨碍做出明智的循证决策的关键知识空白，并推荐未来的研究以填补现有的知识空白。为实现这些目标，对美国心脏病学会/美国心脏协会（ACC/AHA）和美国中风协会（ASA）的现行指南进行了详细审查，以确定明确针对老年人的内容和建议。结果发现，在指导患有心血管疾病的老年人进行临床决策方面普遍缺乏证据，而且关于诊断和治疗干预对老年人尤为重要的结局（如生活质量、身体功能和保持独立）的影响的数据也很少。因此，迫切需要开展大量基于人群的研究和临床试验，纳入广泛的、代表临床实践中所见老年人的样本，并在研究设计中纳入对老年人重要的相关结局。这些研究结果将为未来适用于老年人的循证指南奠定基础，并在美国乃至全球加强对患有心血管疾病的老年人的以患者为中心的护理。
