ACC/AGS/NIA Workshop on Pharmacotherapy in Older Adults with CVD
ACC Heart House, February 6-7, 2017

The second research conference, ACC/AGS/NIA Workshop on Pharmacotherapy in Older Adults with CVD, took place at ACC Heart House on February 6-7, 2017. Workshop attendees included leaders in cardiology and geriatrics (officers in professional societies, journal editors, clinical trialists, prominent division chiefs) and selected trainees and “rising stars” in geriatric cardiology. Officers from the National Institute on Aging, other NIH institutes (National Heart, Lung and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, and National Institute of Nursing Research), key governmental and policy organizations (Food and Drug Administration, Institute of Medicine, Centers for Medicare and Medicaid Services, Alliance for Academic Internal Medicine, Agency for Healthcare Research and Quality), and other major stake holders (Patient-Centered Outcomes Research Institute and pharmaceutical companies).

Short-term objectives for this conference included:

• to engage key stakeholders to identify important research gaps that must be addressed in order to optimize care for older adults with CVD in the context of multimorbidity and complex medication regimens, and
• to formulate multidisciplinary research strategies that will ultimately lead to improved patient-centered care of these patients.

The longer term goal was to incorporate geriatric principles into the care of older adults with or at risk for CVD by developing a more robust evidence base that will enable formulation of guideline and practice recommendations designed to specifically address issues pertinent to the pharmacologic treatment of older adults with CVD. Specific aims of the workshop were to:

• Review current knowledge regarding the complexities of pharmacotherapy in older adults with CVD
• Identify knowledge gaps and unmet needs that must be addressed to move the field forward
• Formulate a prioritized research agenda across the basic, translational, clinical, and population health sciences
• Promote interdisciplinary strategies integrating stakeholders at all levels to address research needs
• Promote the career development of junior investigators committed to research careers at the intersections of CVD, geriatrics, and pharmacology through targeted mentorship.

Background

The pathogenesis and incidence of cardiovascular disease (CVD) are mechanistically linked to aging as well as exposure to conventional CV risk factors. The expanding population of older adults will inevitably be burdened by high prevalence of coronary heart disease, heart failure, valvular heart disease, arrhythmias, peripheral arterial disease, and other CV disease processes. However, caring for older CV patients is often confounded by common geriatric conditions and syndromes (e.g., multimorbidity, cognitive impairment, and frailty) that fundamentally alter the risk: benefit relationship for virtually all diagnostic procedures and therapeutic interventions, including medications proven to be effective in younger, healthier patients. Optimal patient-centered care for the growing population of older adults thus demands that these multiple complex interactions be better delineated and more fully integrated into routine clinical decision-making and drug prescribing for older adults with CVD.

Workshop Planning Committee

Michael W. Rich, MD (Chair), Washington University, St. Louis, MO
Susan P. Bell, MD, Vanderbilt University, Nashville, TN
Daniel E. Forman, MD, University of Pittsburgh, Pittsburgh, PA
John G. Harold, MD, Cedars-Sinai Heart Institute, Los Angeles, CA
Barbara Riegel, PhD, RN, University of Pennsylvania, Philadelphia, PA
Mathew S. Maurer, MD, Columbia University, New York, NY
David B. Reuben, MD, UCLA, Los Angeles, CA
Marcel E. Salive, MD, NIA, Bethesda, MD
Susan J. Zieman, MD, NIA, Bethesda, MD

Workshop Co-chairs

Joseph T. Hanlon, PharmD, University of Pittsburgh, Pittsburgh, PA
Kenneth E. Schmader, MD, Duke University, Durham, NC
Janice B. Schwartz, MD, UCSF, San Francisco, CA

The documents below include links to the slide presentations for each talk. To download the slides, click the session title. Please contact the workshop staff at kbohanno@acc.org, should you require assistance with downloading the slides.

ACC/AGS/NIA Workshop on Pharmacotherapy in Older Adults with CVD
February 6, 2017 from 8:00 a.m. – 5:00 p.m. ET
February 7, 2017 from 8:00 a.m. – Noon ET

• Pharmacotherapy in Older Adults with CVD – Workshop Syllabus
• Workshop Participants List

Satellite Symposium: Research Regarding Older People in Traditional and Non-traditional Sites – Where, Who & How
February 7, 2017 from 1:00 – 4:00 p.m. ET

• Agenda

Satellite Symposium: Early Career Investigators Session
February 7, 2017 from 1:00 – 4:00 p.m. ET

• Agenda

The documents below include links to the slide presentations for each talk. To download the slides, click the session title. Please contact the workshop staff at kbohanno@acc.org, should you require assistance with downloading the slides.

• Workshop Agenda: Pharmacotherapy in Older Adults with Cardiovascular Disease
• Satellite Symposium: Early Career Investigators Session Agenda
• Satellite Symposium: Research Regarding Older People in Traditional and Non-traditional Sites — Where, Who, & How

Workshop Background
ACC Heart House, October 15-16, 2018

The pathogenesis and incidence of cardiovascular disease (CVD) are mechanistically linked to aging as well as exposure to conventional CV risk factors. The expanding population of older adults will inevitably be burdened by high prevalence of coronary heart disease, heart failure, valvular heart disease, arrhythmias, peripheral arterial disease, and other CV disease processes. However, caring for older CV patients is often confounded by common geriatric conditions and syndromes (e.g., multimorbidity, cognitive impairment, and frailty) that fundamentally alter the risk: benefit relationship for virtually all diagnostic procedures and therapeutic interventions. Thus, the value of specific diagnostic tests in older adults is often uncertain, and the impact of testing on outcomes relevant to older adults with CVD, including quality of life and preservation of independence, has not been adequately assessed. Yet, optimal patient-centered care for the growing population of older adults demands that these multiple complex interactions be better delineated and more fully integrated into routine clinical decision-making related to diagnostic testing in older adults with or at risk for CVD.

This workshop, the third in a series of 3 workshops co-sponsored by the American College of Cardiology (ACC), American Geriatrics Society (AGS), and National Institute on Aging (NIA), will focus on Diagnostic Testing in Older Adults with CVD. The primary short-term objectives for this workshop are to engage key stakeholders to identify important research gaps that need to be addressed to optimize the utilization of diagnostic tests for older adults with CVD in the context of multimorbidity and complex medication regimens, and to formulate multidisciplinary research strategies that will ultimately lead to improved patient-centered care for these patients. Longer term goals include the incorporation of geriatrics principles into the care of older adults with CVD by developing a more robust evidence base that will enable formulation of guideline and practice recommendations designed to specifically address issues pertinent to the use of diagnostic tests and procedures in the older adult population.

Specific Aims
The Specific Aims of the workshop are to:

1. Review current knowledge regarding the utility of common diagnostic tests in older adults with CVD
2. Identify knowledge gaps and unmet needs that must be addressed to optimize testing in older adults and to ensure that testing is aligned with individual patients' goals and preferences
3. Formulate a research agenda across the basic, translational, clinical, and population health sciences for future studies designed to address prevalent knowledge gaps
4. Promote interdisciplinary strategies integrating stakeholders at all levels to address research needs
5. Promote the career development of junior investigators committed to research careers at the intersections of CVD and geriatrics through targeted mentorship.

Workshop Planning Committee

Michael W. Rich, MD, Washington University, St. Louis, MO (Chair)
Susan P. Bell, MD, Vanderbilt University, Nashville, TN
Mathew S. Maurer, MD, Columbia University, New York, NY
David B. Reuben, MD, University of California, Los Angeles, Los Angeles, CA
Barbara Riegel, PhD, RN, University of Pennsylvania, Philadelphia, PA
Marcel E. Salive, MD, National Institute on Aging, Bethesda, MD
Susan J. Zieman, MD, National Institute on Aging, Bethesda, MD

Workshop Co-chairs

Daniel E. Forman, MD, University of Pittsburgh, Pittsburgh, PA
Eric D. Peterson, MD, Duke University, Durham, NC
John A. Spertus, MD, University of Missouri, Kansas City, MO

The documents below outline the overall workshop agenda and individual session agendas.

To download presentation slides, click on the corresponding link for each individual day's agenda.

ACC/ AGS/ NIA Diagnostic Testing in Older Adults with CVD: Choosing Wisely Workshop

• Workshop Agenda Book
• Workshop Participants List

U-13 Workshop Day 1
October 15, 2018

• Agenda with Slides

U-13 Workshop Day 2
October 16, 2018

• Agenda with Slides

Early Career Workshop
October 16, 2018

• Early Career Workshop Agenda with Slides