Beyond MACE: a multidimensional approach to outcomes in clinical trials for older adults with stable ischemic heart disease

The global population of older adults is expanding rapidly resulting in a shift towards managing multiple chronic diseases that coexist and may be exacerbated by cardiovascular illness. Stable ischemic heart disease (SIHD) is a predominant contributor to morbidity and mortality in the older adult population. Although results from clinical trials demonstrate that chronological age is a predictor of poor health outcomes, the current management approach remains suboptimal due to insufficient representation of older adults in randomized trials and the inadequate consideration for the interaction between biological aging, concurrent geriatric syndromes, and patient preferences. A shift towards a more patient-centered approach is necessary for appropriately and effectively managing SIHD in the older adult population. In this review, we aim to demonstrate the distinctive needs of older adults who prioritize holistic health outcomes like functional capacity, cognitive abilities, mental health, and quality of life alongside the prevention of major adverse cardiovascular outcomes reported in cardiovascular clinical trials. An individualized, patient-centered approach that involves shared decision-making regarding outcome prioritization is needed when any treatment strategy is being considered. By prioritizing patients and addressing their unique needs for successful aging, we can provide more effective care to a patient population that exhibits the highest cardiovascular risks.

Automated summary

With the rapid expansion of the global older adult population, there is a need to shift towards managing multiple chronic diseases, including cardiovascular illness, which may be exacerbated by other conditions. Stable ischemic heart disease (SIHD) is a leading cause of morbidity and mortality in older adults. However, the current management approach is suboptimal due to insufficient representation of older adults in clinical trials and inadequate consideration of the interaction between biological aging, concurrent geriatric syndromes, and patient preferences. Therefore, a more patient-centered approach is necessary to manage SIHD in older adults, taking into account holistic health outcomes and prevention of major adverse cardiovascular outcomes.