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Review
. 2024 Apr 22;17(8):961-978.
doi: 10.1016/j.jcin.2024.01.284. Epub 2024 Apr 8.

Chronological vs Biological Age in Interventional Cardiology: A Comprehensive Approach to Care for Older Adults: JACC Family Series

Abdulla A Damluji  1 , Michael G Nanna  2 , Jennifer Rymer  3 , Ajar Kochar  4 , Angela Lowenstern  5 , Suzanne J Baron  6 , Craig R Narins  7 , Mohamad Alkhouli  8
Affiliations
Review

Chronological vs Biological Age in Interventional Cardiology: A Comprehensive Approach to Care for Older Adults: JACC Family Series

Abdulla A Damluji et al. JACC Cardiovasc Interv. .

Abstract

Aging is the gradual decline in physical and physiological functioning leading to increased susceptibility to stressors and chronic illnesses, including cardiovascular disease. With an aging global population, in which 1 in 6 individuals will be older than 60 years by 2030, interventional cardiologists are increasingly involved in providing complex care for older individuals. Although procedural aspects remain their main clinical focus, interventionalists frequently encounter age-associated risks that influence eligibility for invasive care, decision making during the intervention, procedural adverse events, and long-term management decisions. The unprecedented growth in transcatheter interventions, especially for structural heart diseases at extremes of age, have pushed age-related risks and implications for cardiovascular care to the forefront. In this JACC state-of-the-art review, the authors provide a comprehensive overview of the aging process as it relates to cardiovascular interventions, with special emphasis on the difference between chronological and biological aging. The authors also address key considerations to improve health outcomes for older patients during and after their invasive cardiovascular care. The role of "gerotherapeutics" in interventional cardiology, technological innovation in measuring biological aging, and the integration of patient-centered outcomes in the older adult population are also discussed.

Keywords: age-associated risks; aging; cardiovascular disease; risk factors; transcatheter therapeutics.

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Conflict of interest statement

Funding Support and Author Disclosures This study was funded in part by a mentored patient-oriented research career development award from the National Heart, Lung, and Blood Institute (K23-HL153771). Dr Damluji has received research funding from the Pepper Scholars Program of the Johns Hopkins University Claude D. Pepper Older Americans Independence Center, funded by National Institute on Aging grant P30-AG021334; a mentored patient-oriented research career development award from the National Heart, Lung, and Blood Institute (K23-HL153771); National Institute of Aging grant R01-AG078153; and the Patient-Centered Outcomes Research Institute. Dr Nanna has received current research support from the American College of Cardiology Foundation, supported by the George F. and Ann Harris Bellows Foundation, the Patient-Centered Outcomes Research Institute, the Yale Claude D. Pepper Older Americans Independence Center (grant P30AG021342), and National Institute on Aging grant R03AG074067 (Grants for Early Medical/Surgical Specialists’ Transition to Aging Research award); and is a consultant for HeartFlow and Merck. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

FIGURE 1
FIGURE 1
Priorities for the Older Adult Population Undergoing Cardiovascular Interventions This figure provides a forward-looking perspective on older patients undergoing percutaneous cardiovascular procedures. Key areas of emphasis include shared decision making, care pathways, the potential for artificial intelligence, and a focus on patient-centric outcomes. LOS = length of stay.
CENTRAL ILLUSTRATION
CENTRAL ILLUSTRATION
Special Considerations for TAVR in the Older Adult Population The figure details the essential elements required for preprocedural evaluation. It also highlights the negative prognostic markers, coexistence of multiple chronic conditions, and the importance for understanding patient goals and postprocedural expectations in older patients undergoing transcatheter aortic valve replacement (TAVR). DNR = do not resuscitate.
See this image and copyright information in PMC

References

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    1. Damluji AA, Forman DE, Wang TY, et al. Management of acute coronary syndrome in the older adult population: a scientific statement from the American Heart Association. Circulation. 2023;147: e32–e62. - PMC - PubMed
    1. Forman DE, Kuchel GA, Newman JC, et al. Impact of geroscience on therapeutic strategies for older adults with cardiovascular disease: JACC scientific statement. J Am Coll Cardiol. 2023;82: 631–647. - PMC - PubMed
    1. Green P, Woglom AE, Genereux P, et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. J Am Coll Cardiol Intv. 2012;5:974–981. - PMC - PubMed
    1. Damluji AA, Rymer JA, Nanna MG. The heterogeneity of old age: healthy aging in older adults undergoing TAVR. J Am Coll Cardiol Intv. 2023;16: 189–192. - PMC - PubMed

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