TY - JOUR
T1 - Pharmacotherapy in Older Adults with Cardiovascular Disease
T2 - Report from an American College of Cardiology, American Geriatrics Society, and National Institute on Aging Workshop
AU - Schwartz, Janice B.
AU - Schmader, Kenneth E.
AU - Hanlon, Joseph T.
AU - Abernethy, Darrell R.
AU - Gray, Shelly
AU - Dunbar-Jacob, Jacqueline
AU - Holmes, Holly M.
AU - Murray, Michael D.
AU - Roberts, Robert
AU - Joyner, Michael
AU - Peterson, Josh
AU - Lindeman, David
AU - Tai-Seale, Ming
AU - Downey, Laura
AU - Rich, Michael W.
N1 - Funding Information:
Funding for this conference was made possible in part by U13 AG 047008 from the National Institute on Aging (Michael W. Rich, MD, PI); by unrestricted grants from Amgen, Pfizer Inc., and Edwards LifeSciences, LLC; and by provision of conference facilities and staffing by the American College of Cardiology. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services or the National Institutes of Health, nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. government. The authors gratefully acknowledge the assistance of Kelli Bohannon, Associate Director, Member Strategy, American College of Cardiology, who provided invaluable support in organizing the workshop; Frances McFarland, PhD, medical writer, who provided a detailed synopsis of the meeting; and Marcel Salive, MD, and Susan Zieman, MD, PhD, who provided valuable input in organizing the workshop. Conflict of Interest: No authors report conflicts of interest. Author Contributions: Janice B Schwartz, MD, Kenneth E Schmader, MD, and Joseph T Hanlon, PharmD, were conference co-chairs and were responsible for choosing and planning talks and editing summaries of all talks and the final manuscript in collaboration with Planning Committee members and Michael W. Rich, MD, Chair of the Planning Committee. Darrell Abernethy, MD, PhD, Shelly Gray, MS, PharmD, Jacqueline Dunbar-Jacob, PhD, RN, Holly M. Holmes, MD, MS, Michael D. Murray, PharmD, MPH, Robert Roberts, MD, Michael Joyner, MD, Josh Peterson, MD, MPH, David Lindeman, PhD, Ming Tai-Seale, PhD, MPH, Laura Downey, DVM, MSM spoke at the meeting and contributed to preparation of the manuscript. Sponsor's Role: NIA representatives (Susan Zieman, MD, PhD, Marcel Salive, MD) participated in planning the workshop, as did representatives of the American College of Cardiology. The industry sponsors (Amgen, Inc., Pfizer Inc., Edwards LifeSciences, LLC) did not contribute to the conference content or manuscript preparation.
Funding Information:
Funding for this conference was made possible in part by U13 AG 047008 from the National Institute on Aging (Michael W. Rich, MD, PI); by unrestricted grants from Amgen, Pfizer Inc., and Edwards LifeSciences, LLC; and by provision of conference facilities and staffing by the American College of Cardiology. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services or the National Institutes of Health, nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. government.
Funding Information:
OBJECTIVES: To identify the top priority areas for research to optimize pharmacotherapy in older adults with cardiovascular disease (CVD). DESIGN: Consensus meeting. SETTING: Multidisciplinary workshop supported by the National Institute on Aging, the American College of Cardiology, and the American Geriatrics Society, February 6–7, 2017.
Publisher Copyright:
© 2018, Copyright the Author Journal compilation © 2018, The American Geriatrics Society
PY - 2019/2
Y1 - 2019/2
N2 - OBJECTIVES: To identify the top priority areas for research to optimize pharmacotherapy in older adults with cardiovascular disease (CVD). DESIGN: Consensus meeting. SETTING: Multidisciplinary workshop supported by the National Institute on Aging, the American College of Cardiology, and the American Geriatrics Society, February 6–7, 2017. PARTICIPANTS: Leaders in the Cardiology and Geriatrics communities, (officers in professional societies, journal editors, clinical trialists, Division chiefs), representatives from the NIA; National Heart, Lung, and Blood Institute; Food and Drug Administration; Centers for Medicare and Medicaid Services, Alliance for Academic Internal Medicine, Patient-Centered Outcomes Research Institute, Agency for Healthcare Research and Quality, pharmaceutical industry, and trainees and early career faculty with interests in geriatric cardiology. MEASUREMENTS: Summary of workshop proceedings and recommendations. RESULTS: To better align older adults’ healthcare preferences with their care, research is needed to improve skills in patient engagement and communication. Similarly, to coordinate and meet the needs of older adults with multiple comorbidities encountering multiple healthcare providers and systems, systems and disciplines must be integrated. The lack of data from efficacy trials of CVD medications relevant to the majority of older adults creates uncertainty in determining the risks and benefits of many CVD therapies; thus, developing evidence-based guidelines for older adults with CVD is a top research priority. Polypharmacy and medication nonadherence lead to poor outcomes in older people, making research on appropriate prescribing and deprescribing to reduce polypharmacy and methods to improve adherence to beneficial therapies a priority. CONCLUSION: The needs and circumstances of older adults with CVD differ from those that the current medical system has been designed to meet. Optimizing pharmacotherapy in older adults will require new data from traditional and pragmatic research to determine optimal CVD therapy, reduce polypharmacy, increase adherence, and meet person-centered goals. Better integration of the multiple systems and disciplines involved in the care of older adults will be essential to implement and disseminate best practices. J Am Geriatr Soc 67:371–380, 2019.
AB - OBJECTIVES: To identify the top priority areas for research to optimize pharmacotherapy in older adults with cardiovascular disease (CVD). DESIGN: Consensus meeting. SETTING: Multidisciplinary workshop supported by the National Institute on Aging, the American College of Cardiology, and the American Geriatrics Society, February 6–7, 2017. PARTICIPANTS: Leaders in the Cardiology and Geriatrics communities, (officers in professional societies, journal editors, clinical trialists, Division chiefs), representatives from the NIA; National Heart, Lung, and Blood Institute; Food and Drug Administration; Centers for Medicare and Medicaid Services, Alliance for Academic Internal Medicine, Patient-Centered Outcomes Research Institute, Agency for Healthcare Research and Quality, pharmaceutical industry, and trainees and early career faculty with interests in geriatric cardiology. MEASUREMENTS: Summary of workshop proceedings and recommendations. RESULTS: To better align older adults’ healthcare preferences with their care, research is needed to improve skills in patient engagement and communication. Similarly, to coordinate and meet the needs of older adults with multiple comorbidities encountering multiple healthcare providers and systems, systems and disciplines must be integrated. The lack of data from efficacy trials of CVD medications relevant to the majority of older adults creates uncertainty in determining the risks and benefits of many CVD therapies; thus, developing evidence-based guidelines for older adults with CVD is a top research priority. Polypharmacy and medication nonadherence lead to poor outcomes in older people, making research on appropriate prescribing and deprescribing to reduce polypharmacy and methods to improve adherence to beneficial therapies a priority. CONCLUSION: The needs and circumstances of older adults with CVD differ from those that the current medical system has been designed to meet. Optimizing pharmacotherapy in older adults will require new data from traditional and pragmatic research to determine optimal CVD therapy, reduce polypharmacy, increase adherence, and meet person-centered goals. Better integration of the multiple systems and disciplines involved in the care of older adults will be essential to implement and disseminate best practices. J Am Geriatr Soc 67:371–380, 2019.
KW - adherence
KW - adverse effects
KW - cardiovascular medication
KW - de-prescribing
KW - polypharmacy
UR - http://www.scopus.com/inward/record.url?scp=85058107648&partnerID=8YFLogxK
U2 - 10.1111/jgs.15634
DO - 10.1111/jgs.15634
M3 - Review article
C2 - 30536694
AN - SCOPUS:85058107648
SN - 0002-8614
VL - 67
SP - 371
EP - 380
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 2
ER -