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Systematic review of clinical practice guidelines recommendations about primary cardiovascular disease prevention for
Jesse Jansen1,2, Shannon McKinn3,4, Carissa Bonner5,6
1Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. jesse.jansen@sydney.edu.au.
Insights
Clinical Practice Guidelines (CPGs) for cardiovascular disease prevention offer limited guidance for older adults. More specific recommendations are needed to ensure high-quality care for this growing patient population.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Clinical Practice Guidelines
Background:
- Older adults are a diverse patient group with complex care needs, multiple comorbidities, and increased susceptibility to treatment harms.
- Clinical Practice Guidelines (CPGs) require careful consideration of older adults to effectively guide clinicians.
- This study reviews CPG recommendations for primary cardiovascular disease (CVD) prevention concerning older adults.
Purpose of the Study:
- To examine the extent to which CPGs for primary CVD prevention address issues pertinent to older adults.
- To assess the discussion of available evidence, implementation barriers, and tailored management for older individuals within CPGs.
Main Methods:
- Searched systematic reviews and multiple databases (National CPG Clearinghouse, G-I-N, Trip) for CPGs on CVD prevention, hypertension, and cholesterol.
- Included CPGs published between April and December 2013, excluding those for specific conditions like diabetes or pediatric populations.
- Extracted data on recommendations for older people, including evidence, barriers, and tailored management, with independent screening by three authors.
Main Results:
- 47 eligible CPGs were identified; 9% did not mention older adults.
- Potential benefits were discussed in 49% and harms in 38% of CPGs.
- While 58% mentioned tailoring management for older patients, concrete guidance was rare, and implementation barriers were often briefly stated.
Conclusions:
- Most CPGs offer vague and limited information on CVD prevention for older adults.
- Guideline developers must prioritize older patients' needs, providing specific advice for high-quality care.
- CPGs should include available evidence on CVD prevention for older people and emphasize patient involvement.
Background:
Clinical care for older adults is complex and represents a growing problem. They are a diverse patient group with varying needs, frequent presence of multiple comorbidities, and are more susceptible to treatment harms. Thus Clinical Practice Guidelines (CPGs) need to carefully consider older adults in order to guide clinicians. We reviewed CPG recommendations for primary cardiovascular disease (CVD) prevention and examined the extent to which CPGs address issues important for older people identified in the literature.
Methods:
We searched: 1) two systematic reviews on CPGs for CVD prevention and 2) the National CPG Clearinghouse, G-I-N International CPG Library and Trip databases for CPGs for CVD prevention, hypertension and cholesterol. We conducted our search between April and December 2013. We excluded CPGs for diabetes, chronic kidney disease, HIV, lifestyle, general screening/prevention, and pregnant or pediatric populations. Three authors independently screened citations for inclusion and extracted data. The primary outcomes were presence and extent of recommendations for older people including discussion of: (1) available evidence, (2) barriers to implementation of the CPG, and (3) tailoring management for this group.
Results:
We found 47 eligible CPGs. There was no mention of older people in 4 (9 %) of the CPGs. Benefits were discussed more frequently than harms. Twenty-three CPGs (49 %) discussed evidence about potential benefits and 18 (38 %) discussed potential harms of CVD prevention in older people. Most CPGs addressed one or more barriers to implementation, often as a short statement. Although 27 CPGs (58 %) mentioned tailoring management to the older patient context (e.g. comorbidities), concrete guidance was rare.
Conclusion:
Although most CVD prevention CPGs mention the older population to some extent, the information provided is vague and very limited. Older adults represent a growing proportion of the population. Guideline developers must ensure they consider older patients' needs and provide appropriate advice to clinicians in order to support high quality care for this group. CPGs should at a minimum address the available evidence about CVD prevention for older people, and acknowledge the importance of patient involvement.
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