Aging is associated with fundamental changes in cardiovascular structure and function that contribute to a progressive increase in the incidence and prevalence of cardiovascular disease (CVD) with advancing age. The traditional paradigm of care for older adults with CVD has focused primarily on specific disorders, such as coronary artery disease, aortic stenosis, heart failure, or atrial fibrillation, and has failed to integrate prevalent geriatric syndromes, e.g. multimorbidity, polypharmacy, cognitive impairment, and frailty, into clinical care and decision-making. A critical factor contributing to the current inadequacies in care for older patients with CVD is the marked deficiency of evidence upon which to formulate guidelines for management of the complex and heterogeneous population of older adults with CVD. Thus, the Specific Aims of this U13 application, submitted under the auspices of the American College of Cardiology Council on Cardiovascular Care for Older Adults (CCCOA), in collaboration with the American Geriatrics Society and the National Institute on Aging, are to (1) identify critical knowledge gaps and research priorities for optimizing patient-centered care and outcomes for older adults with CVD by conducting a series of 3 biannual interdisciplinary workshops focusing on the intersections between CVD and multimorbidity, polypharmacy, and optimal diagnostic testing in older adults;(2) promote geriatric medicine and gerontology research within the cardiology community by providing a forum for direct interactions between senior investigators and academic leaders in geriatrics and cardiology;and (3) promote the development of a new generation of investigators committed to advancing the scientific underpinnings of gerocardiology through a Young Investigators Travel Award program. Workshops will take place at Heart House, ACC's premier conference center in Washington, DC, and will include representatives from NIA, other NIH ICs (NHLBI, NIDDK, NINR), key governmental and policy organizations (FDA, IOM, CMS, AAIM, AARP), and other major stake holders (PCORI, AHRQ, NQF, drug and device companies), in addition to influential leaders in cardiology and geriatrics (officers in professional societies, journal editors, clinical trialists, prominent division chiefs) and selected trainees and "rising stars" in geriatric cardiolgy. Workshops will include didactic presentations with ample time for discussion and multiple breakout groups charged with identifying current clinical and research needs, determining what resources are required to address the current needs, and formulating a prioritized research agenda that can be translated into specific RFAs and PAs. Conference proceedings and recommendations will be widely disseminated through ACC's extensive communications network, publication in top-tier peer-reviewed journals (e.g. JACC, JAGS), development of a conference website, and hosting of webinars. Ultimately, it is anticipated that the conferences will fuel an upsurge in research in CVD in older adults with complex comorbidities that will translate into new patient- centered guidelines and performance measures leading to improved care and clinical outcomes.
The American College of Cardiology project Integration of Geriatrics Principles into the Care of Older Adults with Cardiovascular Disease focuses on developing new approaches to improving care and outcomes in older patients who have heart disease in combination with other conditions commonly present in older adults, such as memory problems, declining physical function, and frailty. The project, which is cosponsored by the American Geriatrics Society and the National Institute on Aging, will help define research priorities for gaining a better understanding of how best to care for older patients in whom heart disease is just one of several chronic illnesses, and to determine which diagnostic tests and procedures are most useful for achieving desired outcomes in individual patients. The project will also examine possible differences in care and outcomes according to age, gender, and race or ethnicity. Additional goals are to develop educational materials for the broader community of cardiology specialists, to stimulate early-career researchers to pursue studies involving older cardiac patients, and to widely disseminate the results and recommendations of the project to physicians, nurses, and other health professionals who provide care for older adults with heart disease.