The future of cardiovascular care for older adults is a critical topic, and experts are stepping up to address the unique challenges faced by this demographic. At the American Heart Association's 2025 Scientific Sessions, the focus was on how we can improve care models and clinical trials to better serve our aging population.
The Imperative for Change
Cardiology and research must adapt to the realities of aging. Older adults are often underrepresented in cardiovascular research, face unique barriers to managing hypertension, and are at a higher risk of polypharmacy and overtreatment. It's time to reshape our approach.
Digital Tools: A Double-Edged Sword
John A. Dodson, MD, MPH, an associate professor at New York University, highlighted the potential of digital health to bridge the gap in blood pressure control. Despite the increasing use of mobile devices, older adults still face challenges due to comorbidities, mobility issues, and medication adherence. Dodson emphasized that the success of digital tools depends on understanding the real-world barriers these individuals encounter.
But here's where it gets controversial: Dodson pointed out the 'utility cost' - the effort required to adopt new technology. Privacy concerns, resistance to change, and physical limitations like impaired vision, hearing loss, or cognitive decline, can all hinder device usage. It's not as simple as asking patients to pick up their phones.
The RESILIENT trial tested mobile health-based cardiac rehabilitation (mHealth-CR) among older adults with ischemic heart disease. While it didn't significantly improve functional capacity, patient engagement played a crucial role. Those who fully participated saw improvements, suggesting that motivation and support are key.
Dodson believes that selecting the right patients or providing the right motivation could make digital interventions effective. The BETTER-BP study, which combined behavioral economics and text messaging, achieved an impressive 87% retention rate by meeting patients' needs with bilingual staff, transportation reimbursement, and real-time support.
Expanding Representation in Trials
Michael Nanna, MD, MHS, an assistant professor at Yale School of Medicine, addressed the underrepresentation of older adults in coronary artery disease research. While age-based exclusions are less common, comorbidities, frailty, transportation issues, and polypharmacy concerns still indirectly exclude this demographic.
Nanna emphasized the need for generalizable results, which requires enrolling patients across the biological aging spectrum. The LIVEBETTER study, sponsored by PCORI, compared beta-blockers and calcium channel blockers for angina management in older adults. What sets it apart is its focus on global quality of life, a patient-centric outcome.
Engaging caregivers is crucial for successfully enrolling older adults in trials, and the LIVEBETTER study did just that. It enrolled patient caregivers alongside their partners and assessed caregiver burden longitudinally. The study also incorporated remote follow-ups and community partnerships to reduce barriers.
Deprescribing: Weighing Benefits and Risks
Mark Effron, MD, a professor at Ochsner Health, shifted the discussion to deprescribing and medication burden. He presented a real-world case where a patient met guideline-directed medical therapy criteria for four conditions, resulting in up to eleven medication classes just for heart disease.
While medications manage cardiovascular disease, their cumulative burden can create new health risks, especially for older adults. Poor adherence, drug interactions, falls, disability, hospitalizations, and even adverse cardiovascular outcomes are all potential consequences. Effron described this as an 'inherent tension' between therapy and polypharmacy, where clinicians must constantly evaluate the risks and benefits of each drug, especially when they don't align with the patient's goals.
Effron also warned of 'therapeutic competition,' where treating one condition can worsen another. For older adults with comorbidities, these cascading effects require careful monitoring and a patient-centered approach.
Two deprescribing trials, the Veterans Affairs study and the OPTIMISE trial, found no increase in mortality or cardiovascular events after reducing antihypertensive medications. Effron also discussed the promise of n-of-1 trials, which test medication withdrawal within individual patients to guide personalized decisions.
As we move forward, it's clear that improving patient-centered cardiovascular care for older adults requires a multi-faceted approach. Digital tools, inclusive trials, and safer deprescribing practices are all part of the solution. The question remains: How can we best implement these changes to ensure the best care for our aging population? We invite you to share your thoughts and experiences in the comments below.
