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Clin-STAR corner: Practice changing advances in cardiology

Mustafa Husaini1, Michael W Rich1

  • 1Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA.

Journal of the American Geriatrics Society
|December 16, 2022
PubMed

Insights

Older adults with stable ischemic heart disease can benefit from a conservative approach. Recent trials show empagliflozin reduces heart failure hospitalizations, while tailored rehabilitation aids recovery, and low-sodium diets offer limited benefit.

Area of Science:

  • Cardiology
  • Geriatrics
  • Clinical Trials

Background:

  • Cardiovascular disease is a leading cause of death and disability in older adults.
  • Older adults are under-represented in cardiovascular clinical trials, limiting evidence-based care.

Purpose of the Study:

  • To summarize recent (2020-2022) practice-changing cardiovascular trial findings directly applicable to older adults.
  • To highlight key implications for managing cardiovascular conditions in geriatric populations.

Main Methods:

  • Review of four cardiovascular clinical trials published between 2020 and 2022.
  • Focus on trials with direct relevance and implications for the care of older patients.

Main Results:

  • A conservative management strategy is reasonable for selected patients with stable ischemic heart disease, even with moderate to severe ischemia.
  • Empagliflozin significantly reduces heart failure hospitalizations in patients with heart failure and preserved ejection fraction, irrespective of diabetes status.
  • Tailored physical rehabilitation programs improve outcomes for older patients hospitalized with heart failure, reducing deconditioning and functional decline.
  • Restricting dietary sodium intake to <1500 mg/day is unlikely to improve outcomes for most heart failure patients.

Conclusions:

  • Recent cardiovascular trials offer significant advancements in the care of older adults.
  • Evidence supports conservative management, specific pharmacotherapy (empagliflozin), and rehabilitation for improved cardiovascular outcomes in older populations.
  • Dietary sodium restriction may not be universally beneficial for heart failure management in this demographic.

Keywords:
cardiologyheart failureischemic heart diseaserehabilitationsodium-glucose cotransporter-2 (SGLT2) inhibitors

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