Table 3.
Gaps and Challenges in Geriatric Cardiology
| I. Research |
| A. Increased enrollment of older adults in clinical studies, including women, racial and ethnic minorities, nursing home residents, and complex elders with multimorbidity, frailty, functional and cognitive limitations |
| B. Incorporation of outcomes relevant to older adults into clinical study design, including quality of life, maintenance of independence, physical and cognitive function |
| C. Expanded studies in geroscience to clarify mechanisms of cardiovascular aging and intersections with geriatrics, oncology, and other specialties as related with aging |
| II. Clinical care |
| A. Integration of geriatrics constructs into the care of older adults with cardiovascular disease in the inpatient and ambulatory settings |
| B. Continued alignment of clinical practice guidelines, appropriate use documents, and consensus statements with current knowledge and evidence pertinent to older adults, acknowledging where data are insufficient to make recommendations |
| C. Use of gerotechnology for improved quality and efficiency of health care delivery |
| D. Activation and integration of multiple disciplines to provide care to older adults (pharmacists, physical and occupational therapists, social workers, etc) |
| III. Education |
| A. Increased education of clinicians caring for older adults, including physicians, advanced practice providers, and pharmacists, about geriatric principles of care, starting with professional school training and continuing throughout professional life |
| B. Integration of geriatric cardiology knowledge and competencies into the COCATS guidelines for training of fellows in cardiovascular disease |
| IV. Public policy |
| A. Revision of CMS reimbursement models to better reflect time required to provide optimal multidisciplinary patient-centered care to complex older adults and better support integrated interdisciplinary models of care |
| B. Increased requirements by FDA to ensure that drugs and devices intended for use in older adults have been adequately tested in this population and to ensure adequate post-approval surveillance to identify unanticipated adverse events |
CMS = Centers for Medicare & Medicaid Services; COCATS = Core Cardiology Training Symposium; FDA = Food and Drug Administration.