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Women and elderly: subgroups under-represented in clinical trials
1University of Auckland Waikato Hospital, Hamilton, New Zealand. devling@waikatodhb.govt.nz
Current Opinion in Cardiology
|April 14, 2010
Summary
Women and older patients with cardiovascular disease often receive suboptimal care. Evidence suggests they benefit similarly to younger males from evidence-based treatments for ischemic heart disease and heart failure.
Area of Science:
- Cardiology
- Clinical Medicine
- Evidence-Based Practice
Background:
- Cardiovascular disease management often underinvests in women and older adults.
- A perceived lack of sex- and age-specific trial data contributes to this disparity.
- This review examines the evidence for managing ischemic heart disease and heart failure in these populations.
Purpose of the Study:
- To review the current evidence base for managing ischemic heart disease and heart failure in women and older patients.
- To address the underinvestigation and undertreatment of these demographic groups.
- To compare treatment outcomes and benefits between women, older adults, and younger males.
Main Methods:
- Systematic review of available clinical trial evidence and meta-analyses.
- Analysis of registry data on the care of women and older patients with cardiovascular disease.
- Comparison of treatment efficacy and outcomes across different demographic groups.
Main Results:
- Registry data confirm suboptimal care for women and older patients with ischemic heart disease and heart failure.
- Recent trials and meta-analyses indicate similar benefits for women and older adults compared to younger males.
- An exception may be implantable cardioverter-defibrillator implantation in females.
Conclusions:
- Women and older patients should receive similar evidence-based treatment for cardiovascular risk factors, ischemic heart disease, and heart failure as younger males.
- Further sex- and age-specific trials are needed to refine treatment protocols, including dosing and complication management.
- Current evidence does not support the differential treatment of women and older adults in cardiovascular disease management.
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