Systematic review of clinical practice guidelines recommendations about primary cardiovascular disease prevention for older adults

Jesse Jansen^{1

2}, Shannon McKinn^{3

4}, Carissa Bonner^{5

6}, Les Irwig⁷, Jenny Doust^{8

9}, Paul Glasziou^{10

11}, Brooke Nickel^{12

13}, Barbara van Munster^{14

15}, Kirsten McCaffery^{16

17}

Affiliations

¹ Screening & 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.
² Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. jesse.jansen@sydney.edu.au.
³ Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. shannon.mckinn@sydney.edu.au.
⁴ Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. shannon.mckinn@sydney.edu.au.
⁵ Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. carissa.bonner@sydney.edu.au.
⁶ Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. carissa.bonner@sydney.edu.au.
⁷ Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. les.irwig@sydney.edu.au.
⁸ Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. jdoust@bond.edu.au.
⁹ Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia. jdoust@bond.edu.au.
¹⁰ Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. pglaszio@bond.edu.au.
¹¹ Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia. pglaszio@bond.edu.au.
¹² Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. brooke.nickel@sydney.edu.au.
¹³ Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. brooke.nickel@sydney.edu.au.
¹⁴ Academic Medical Centre, Department of Internal Medicine, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. b.c.vanmunster@amc.uva.nl.
¹⁵ Department of Geriatrics, Gelre Hospitaal, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, Netherlands. b.c.vanmunster@amc.uva.nl.
¹⁶ Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. kirsten.mccaffery@sydney.edu.au.
¹⁷ Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. kirsten.mccaffery@sydney.edu.au.

PMID: 26289559
PMCID: PMC4546022
DOI: 10.1186/s12875-015-0310-1

Systematic review of clinical practice guidelines recommendations about primary cardiovascular disease prevention for older adults

Jesse Jansen et al. BMC Fam Pract. 2015.

. 2015 Aug 20:16:104.

doi: 10.1186/s12875-015-0310-1.

Authors

Affiliations

¹ Screening & 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.
² Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. jesse.jansen@sydney.edu.au.
³ Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. shannon.mckinn@sydney.edu.au.
⁴ Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. shannon.mckinn@sydney.edu.au.
⁵ Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. carissa.bonner@sydney.edu.au.
⁶ Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. carissa.bonner@sydney.edu.au.
⁷ Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. les.irwig@sydney.edu.au.
⁸ Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. jdoust@bond.edu.au.
⁹ Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia. jdoust@bond.edu.au.
¹⁰ Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. pglaszio@bond.edu.au.
¹¹ Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia. pglaszio@bond.edu.au.
¹² Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. brooke.nickel@sydney.edu.au.
¹³ Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. brooke.nickel@sydney.edu.au.
¹⁴ Academic Medical Centre, Department of Internal Medicine, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. b.c.vanmunster@amc.uva.nl.
¹⁵ Department of Geriatrics, Gelre Hospitaal, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, Netherlands. b.c.vanmunster@amc.uva.nl.
¹⁶ Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. kirsten.mccaffery@sydney.edu.au.
¹⁷ Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia. kirsten.mccaffery@sydney.edu.au.

PMID: 26289559
PMCID: PMC4546022
DOI: 10.1186/s12875-015-0310-1

Abstract

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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Figures

**Fig. 1**
Summary of CPG search and review process

**Fig. 2**
Available evidence different CVD risk management strategies (primary prevention) as mentioned in the CPGs (n = 47). Legend: *No harms or knowledge gaps mentioned for lifestyle. Abbreviations: assess/mgt = assessment/management, BP = blood pressure, *meds* = medication, chol = cholesterol

**Fig. 3**
Barriers to implementation of the guideline for older people as mentioned in CPGs. Legend: Percentage of total number of guidelines n = 47; *Calculated out of 34 (23 CVD + 11 hypertension) CPGs

**Fig. 4**
Tailoring treatment to older people context and preferences as mentioned in CPGs. Legend: Percentage of total number of guidelines n = 47

See this image and copyright information in PMC

References

1. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. Jama. 2005;294:716–24. doi: 10.1001/jama.294.6.716. - DOI - PubMed
1. Scott IA, Guyatt GH. Cautionary tales in the interpretation of clinical studies involving older persons. Arch Intern Med. 2010;170:587–95. doi: 10.1001/archinternmed.2010.18. - DOI - PubMed
1. Nair BR. Evidence based medicine for older people: available, accessible, acceptable, adaptable? Australas J Ageing. 2002;21:58–60. doi: 10.1111/j.1741-6612.2002.tb00418.x. - DOI
1. American Geriatrics Society. Expert Panel on the Care of Older Adults with Multimorbidity Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the American Geriatrics Society. J Am Geriatr Soc. 2012;60:1957–68. doi: 10.1111/j.1532-5415.2012.04187.x. - DOI - PMC - PubMed
1. Islam MM, Valderas JM, Yen L, Dawda P, Jowsey T, McRae IS. Multimorbidity and comorbidity of chronic diseases among the senior Australians: prevalence and patterns. PLoS One. 2014;9 doi: 10.1371/journal.pone.0083783. - DOI - PMC - PubMed

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Systematic review of clinical practice guidelines recommendations about primary cardiovascular disease prevention for older adults

Affiliations

Systematic review of clinical practice guidelines recommendations about primary cardiovascular disease prevention for older adults

Authors

Affiliations

Abstract

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Full Text Sources

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