Cardiovascular Department, San Gerardo Hospital of Monza, Via G. B. Pergolesi, 33, 20900 Monza MB, Italy.
Department of Internal Medicine, Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, Krems, Austria.
Eur J Prev Cardiol. 2022 Aug 5;29(10):1412-1424. doi: 10.1093/eurjpc/zwac033.
The growing elderly population worldwide represents a major challenge for caregivers, healthcare providers, and society. Older patients have a higher prevalence of cardiovascular (CV) disease, high rates of CV risk factors, and multiple age-related comorbidities. Although prevention and management strategies have been shown to be effective in older people, they continue to be under-used, and under-studied. In addition to hard endpoints, frailty, cognitive impairments, and patients' re-assessment of important outcomes (e.g. quality of life vs. longevity) are important aspects for older patients and emphasize the need to include a substantial proportion of older patients in CV clinical trials. To complement the often skewed age distribution in clinical trials, greater emphasis should be placed on real-world studies to assess longer-term outcomes, especially safety and quality of life outcomes. In the complex environment of the older patient, a multidisciplinary care team approach with the involvement of the individual patient in the decision-making process can help optimize prevention and management strategies. This article aims to demonstrate the growing burden of ageing in real life and illustrates the need to continue primary prevention to address CV risk factors. It summarizes factors to consider when choosing pharmacological and interventional treatments for the elderly and the need to consider quality of life and patient priorities when making decisions.
全球不断增长的老年人口对护理人员、医疗保健提供者和社会构成了重大挑战。老年患者心血管疾病（CV）的患病率更高，CV 风险因素的发生率更高，并且存在多种与年龄相关的合并症。尽管已证明预防和管理策略对老年人有效，但它们的使用和研究仍然不足。除了硬性终点外，虚弱、认知障碍以及患者对重要结局（例如生活质量与寿命）的重新评估是老年患者的重要方面，这强调了需要让相当一部分老年患者参与 CV 临床试验。为了补充临床试验中经常存在的年龄分布偏倚，应更加重视真实世界研究，以评估更长期的结局，尤其是安全性和生活质量结局。在老年患者复杂的环境中，多学科护理团队方法以及让患者参与决策过程可以帮助优化预防和管理策略。本文旨在展示现实生活中老龄化的日益加重，并说明需要继续进行一级预防以解决 CV 风险因素。它总结了在为老年人选择药物和介入治疗时需要考虑的因素，以及在做出决策时需要考虑生活质量和患者优先事项的必要性。
