PR O G RE S S I N C ARDI O V A S CU L A R D I S EA S E S 5 7 (2 0 1 4) 12 5–1 2 6
Available online at www.sciencedirect.com
ScienceDirect www.onlinepcd.com
Editorial
Bringing Geriatric Cardiology to the Next Level This issue of Progress in Cardiovascular Disease focuses on some of the many issues pertaining to the important challenge of improving cardiovascular (CV) healthcare for the older adult population. Average longevity has been steadily increasing for decades; mean lifespan for women and men in the US was 80 years in 2013,1 implying that about half the population lives well beyond that age. The subset of adults aged 85 and older is the world's most rapidly growing demographic.2 Aging biology fundamentally overlaps with CV pathophysiology, and the expanding senior adult population is inherently predisposed to CV disease (CVD).3 Nonetheless, traditional evidence-based standards for coronary heart disease (CHD), heart failure (HF), valvular heart disease, peripheral arterial disease, arrhythmia, and other CV processes are primarily oriented to younger adults. Despite endorsing the concept of both evidence-based management and patient-centered care, today's CV guidelines lack specific recommendations regarding age-related health complexities, essentially overlooking factors which pervasively confound therapeutic efficacy of standard management for the majority of eligible patients.4 Almost every aspect of CV care in older adults is transformed by age-related complexities, e.g., high bleeding risk among elderly CHD patients needing anti-thrombin agents; high falling risk among elderly hypertensive patients needing blood pressure lowering medications; increased incontinence among HF patients needing diuretics, such that current standards of management often yield greater risk than benefit, and/or uncertain benefits even if treatments are successfully initiated.5 There is critical need to reconsider and study current standards for assessment and management, and to better incorporate elements of higher absolute benefit for patients with high mortality and morbidity risk from their disease, but also to higher absolute iatrogenic risk that comes with advancing age. Pertinent considerations include better
understanding of aging biology and the idiosyncratic complexities of CVD among elderly (e.g., increased oxidative stress, telomere changes), as well as the related implications for disease risk stratification, disease management (including age-relevant outcome goals like function and quality of life), therapeutic efficacy (pharmacological, procedures, and/or devices), and the process of care (e.g., effects of hospitalizations and transfers). In this issue we focus on some of the myriad of these relevant issues. A series of manuscripts focus on issues of risk stratification, prevention (cardiac rehabilitation, lipids), process of care (CHD, transcutaneous aortic valve replacement, imaging), as well as reviews regarding weight and frailty in relation to age. The overarching goal of this special issue is to highlight the tremendous relevance of aging dynamics in achieving care that best meets the needs of our patients. It is a particular pleasure to serve as guest editor at this point in my career. My strong commitment to the goal of improving CV care for older adults has led to my decision to transition to a new position as chair of a new Section of Geriatric Cardiology at the University of Pittsburgh. I am grateful to the University of Pittsburgh for its bold commitment toward these goals, and for its support of a multi-faceted and ambitious agenda. It is also pleasing to report that the American College of Cardiology's Section of Geriatric Cardiology has continued to grow and flourish, with membership exceeding 2000 cardiologists, nurse practitioners and other members of the CV team, as well as over 500 fellows-in-training, and a rich portfolio of activities including NIH-sponsored conferences, robust research activities, and fundamental impact on the basic goals and priorities of the college. Just as the field of cardiology has expanded over the past two decades to include principles of vascular medicine,
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PR O GRE S S I N C ARDI O VAS CU L AR D I S EAS E S 5 7 ( 2 0 14 ) 12 5–1 26
Abbreviations and Acronyms CV = cardiovascular CVD = cardiovascular disease CHD = coronary heart disease HF = heart failure
hematology, and inflammation as part of an increasingly sophisticated paradigm of disease and health, this issue (and many parallel efforts) heralds the evolving integration of cardiology and geriatrics.
REFERENCES
1. WHO. Life expectancy. http://en.wikipedia.org/wiki/ List_of_countries_by_life_expectancy. 2. http://transgenerational.org/aging/demographics.htm. 3. Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part I:
aging arteries: a “set up” for vascular disease. Circulation. 2003;107:139-146. 4. Forman DE, Rich MW, Alexander KP, Zieman S, Maurer MS, Najjar SS, et al. Cardiac care for older adults. Time for a new paradigm. J Am Coll Cardiol. 2011;57:1801-1810. 5. Forman DE, Wenger NK. What do the recent American Heart Association/American College of Cardiology Foundation Clinical Practice Guidelines tell us about the evolving management of coronary heart disease in older adults? J Geriatr Cardiol. 2013;10:123-128.
Daniel E. Forman Chair, Geriatric Cardiology Section University of Pittsburgh Medical Center Immediate Past Chair Geriatric Cardiology Section, American College of Cardiology. 3471 Fifth Avenue Suite 500 Pittsburgh, PA 15213 E-mail address: [email protected]
0033-0620 © 2014 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.pcad.2014.07.001
Available online at www.sciencedirect.com
ScienceDirect www.onlinepcd.com
Editorial
Bringing Geriatric Cardiology to the Next Level This issue of Progress in Cardiovascular Disease focuses on some of the many issues pertaining to the important challenge of improving cardiovascular (CV) healthcare for the older adult population. Average longevity has been steadily increasing for decades; mean lifespan for women and men in the US was 80 years in 2013,1 implying that about half the population lives well beyond that age. The subset of adults aged 85 and older is the world's most rapidly growing demographic.2 Aging biology fundamentally overlaps with CV pathophysiology, and the expanding senior adult population is inherently predisposed to CV disease (CVD).3 Nonetheless, traditional evidence-based standards for coronary heart disease (CHD), heart failure (HF), valvular heart disease, peripheral arterial disease, arrhythmia, and other CV processes are primarily oriented to younger adults. Despite endorsing the concept of both evidence-based management and patient-centered care, today's CV guidelines lack specific recommendations regarding age-related health complexities, essentially overlooking factors which pervasively confound therapeutic efficacy of standard management for the majority of eligible patients.4 Almost every aspect of CV care in older adults is transformed by age-related complexities, e.g., high bleeding risk among elderly CHD patients needing anti-thrombin agents; high falling risk among elderly hypertensive patients needing blood pressure lowering medications; increased incontinence among HF patients needing diuretics, such that current standards of management often yield greater risk than benefit, and/or uncertain benefits even if treatments are successfully initiated.5 There is critical need to reconsider and study current standards for assessment and management, and to better incorporate elements of higher absolute benefit for patients with high mortality and morbidity risk from their disease, but also to higher absolute iatrogenic risk that comes with advancing age. Pertinent considerations include better
understanding of aging biology and the idiosyncratic complexities of CVD among elderly (e.g., increased oxidative stress, telomere changes), as well as the related implications for disease risk stratification, disease management (including age-relevant outcome goals like function and quality of life), therapeutic efficacy (pharmacological, procedures, and/or devices), and the process of care (e.g., effects of hospitalizations and transfers). In this issue we focus on some of the myriad of these relevant issues. A series of manuscripts focus on issues of risk stratification, prevention (cardiac rehabilitation, lipids), process of care (CHD, transcutaneous aortic valve replacement, imaging), as well as reviews regarding weight and frailty in relation to age. The overarching goal of this special issue is to highlight the tremendous relevance of aging dynamics in achieving care that best meets the needs of our patients. It is a particular pleasure to serve as guest editor at this point in my career. My strong commitment to the goal of improving CV care for older adults has led to my decision to transition to a new position as chair of a new Section of Geriatric Cardiology at the University of Pittsburgh. I am grateful to the University of Pittsburgh for its bold commitment toward these goals, and for its support of a multi-faceted and ambitious agenda. It is also pleasing to report that the American College of Cardiology's Section of Geriatric Cardiology has continued to grow and flourish, with membership exceeding 2000 cardiologists, nurse practitioners and other members of the CV team, as well as over 500 fellows-in-training, and a rich portfolio of activities including NIH-sponsored conferences, robust research activities, and fundamental impact on the basic goals and priorities of the college. Just as the field of cardiology has expanded over the past two decades to include principles of vascular medicine,
126
PR O GRE S S I N C ARDI O VAS CU L AR D I S EAS E S 5 7 ( 2 0 14 ) 12 5–1 26
Abbreviations and Acronyms CV = cardiovascular CVD = cardiovascular disease CHD = coronary heart disease HF = heart failure
hematology, and inflammation as part of an increasingly sophisticated paradigm of disease and health, this issue (and many parallel efforts) heralds the evolving integration of cardiology and geriatrics.
REFERENCES
1. WHO. Life expectancy. http://en.wikipedia.org/wiki/ List_of_countries_by_life_expectancy. 2. http://transgenerational.org/aging/demographics.htm. 3. Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part I:
aging arteries: a “set up” for vascular disease. Circulation. 2003;107:139-146. 4. Forman DE, Rich MW, Alexander KP, Zieman S, Maurer MS, Najjar SS, et al. Cardiac care for older adults. Time for a new paradigm. J Am Coll Cardiol. 2011;57:1801-1810. 5. Forman DE, Wenger NK. What do the recent American Heart Association/American College of Cardiology Foundation Clinical Practice Guidelines tell us about the evolving management of coronary heart disease in older adults? J Geriatr Cardiol. 2013;10:123-128.
Daniel E. Forman Chair, Geriatric Cardiology Section University of Pittsburgh Medical Center Immediate Past Chair Geriatric Cardiology Section, American College of Cardiology. 3471 Fifth Avenue Suite 500 Pittsburgh, PA 15213 E-mail address: [email protected]
0033-0620 © 2014 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.pcad.2014.07.001
