Further research may be needed to better align diagnostic testing for cardiovascular disease (CVD) with the needs and priorities of an aging population, according to a perspective from ACC's Geriatric Cardiology Section Leadership Council published Sept. 21 in the Journal of the American College of Cardiology.

Daniel E. Forman, MD, FACC, et al., explain how age-related biological changes and shifting patient priorities warrant adjustment of strategies for evaluation and management of cardiovascular disease. This issue was addressed at a two-day multidisciplinary workshop, "Diagnostic Testing in Older Adults with Cardiovascular Disease," with the ACC and National Institutes on Aging, in collaboration with the American Geriatrics Society. The primary goal of the workshop was to identify knowledge gaps and formulate research strategies to advance the utility and value of cardiovascular testing for older adults.

Just as aging is conducive to physiological changes that predispose to cardiovascular disease, the authors note it is also accompanied by physiological and social dimensions that confound many aspects of testing itself, testing interpretation and traditional cardiovascular disease management goals.

Among the key limitations, the authors explain how diagnostic testing in older adults lacks age-based normative ranges from which to best gauge disease, and there is relatively little integration of testing metrics with patient-reported outcomes (in contrast with extensive data linking testing metrics with disease outcomes).

According to the authors, key priorities going forward are to ensure adequate representation of diverse older adults in studies of testing strategies and modalities; create shared decision-making tools that can transparently estimate the outcomes of one testing strategy vs. another based on patients' age and comorbidities; integrate patients' goals and preferences into decision making; and assess "value" of each test based on patient factors, relevant outcomes and geriatrics perspectives.

"Whereas testing has the potential to illuminate critical findings that could guide care, it cannot be presumed that testing leads to interventions and outcomes that all older patients perceive as beneficial in relation to their overarching life concerns," the authors write. "Additional interdisciplinary research is essential to better inform test selection and interpretation for older adults who routinely develop cardiovascular disease in a context of clinical complexity and who are now, de facto, 'typical' cardiovascular patients."

Clinical Topics: Geriatric Cardiology

Keywords: Geriatrics, Cardiovascular Diseases, Decision Making, Comorbidity, Aging, Treatment Outcome, Decision Making, Organizational, Patient-Centered Care

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