Beyond MACE: a multidimensional approach to outcomes in clinical trials for older adults with stable ischemic heart disease.

Autor:	Kalra K; Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States., Moumneh MB; Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States., Nanna MG; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States., Damluji AA; Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States.; Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2023 Nov 17; Vol. 10, pp. 1276370. Date of Electronic Publication: 2023 Nov 17 (Print Publication: 2023).
DOI:	10.3389/fcvm.2023.1276370
Abstrakt:	The global population of older adults is expanding rapidly resulting in a shift towards managing multiple chronic diseases that coexist and may be exacerbated by cardiovascular illness. Stable ischemic heart disease (SIHD) is a predominant contributor to morbidity and mortality in the older adult population. Although results from clinical trials demonstrate that chronological age is a predictor of poor health outcomes, the current management approach remains suboptimal due to insufficient representation of older adults in randomized trials and the inadequate consideration for the interaction between biological aging, concurrent geriatric syndromes, and patient preferences. A shift towards a more patient-centered approach is necessary for appropriately and effectively managing SIHD in the older adult population. In this review, we aim to demonstrate the distinctive needs of older adults who prioritize holistic health outcomes like functional capacity, cognitive abilities, mental health, and quality of life alongside the prevention of major adverse cardiovascular outcomes reported in cardiovascular clinical trials. An individualized, patient-centered approach that involves shared decision-making regarding outcome prioritization is needed when any treatment strategy is being considered. By prioritizing patients and addressing their unique needs for successful aging, we can provide more effective care to a patient population that exhibits the highest cardiovascular risks. Competing Interests: MN receives consulting fees from Heartflow, Inc, Merck. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2023 Kalra, Moumneh, Nanna and Damluji.)
Databáze:	MEDLINE
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