Parag Goyal1, Eiran Z Gorodeski2, Kelsey M Flint3, Deena S Goldwater4, John A Dodson5, Jonathan Afilalo6, Mathew S Maurer7, Michael W Rich8, Karen P Alexander9, Scott L Hummel10. 1. Weill Cornell Medicine, New York, New York. 2. Case Western Reserve University School of Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio. 3. Rocky Mountain Regional Veterans Affairs (VA) Medical Center, University of Colorado School of Medicine, Aurora, Colorado. 4. University of California, Los Angeles, Los Angeles, California. 5. New York University School of Medicine, New York, New York. 6. Jewish General Hospital, McGill University, Montreal, Quebec, Canada. 7. Columbia University Irving Medical Center, New York, New York. 8. Washington University School of Medicine, St Louis, Missouri. 9. Duke University, Duke Clinical Research Institute, Durham, North Carolina. 10. University of Michigan and Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan.
Abstract
BACKGROUND/ OBJECTIVES: The American College of Cardiology (ACC) Geriatric Cardiology Section Leadership Council recently outlined 4 key domains (which are composed of 14 subdomains) that are important to assess in older adults with heart failure (HF). We sought to determine which geriatric domains/subdomains are routinely assessed, how they are assessed, and how they impact clinical management in the care of ambulatory older adults with HF. DESIGN: Survey. SETTING: Ambulatory. PARTICIPANTS: Fifteen active ACC member physicians from the geriatric cardiology community. MEASUREMENTS: Electronic survey assessing which domains/subdomains are currently assessed in these selected real-world practices, how they are assessed, and how they are incorporated into clinical management. RESULTS: Of 15 clinicians, 14 responded to the survey. The majority routinely assess 3 to 4 domains (median, 3; interquartile range, 3-4) and a range of 4 to 12 subdomains (median, 8; interquartile range, 6-11). All respondents routinely assess the medical and physical function domains, 71% routinely assess the mind/emotion domain, and 50% routinely assess the social domain. The most common subdomains included comorbidity burden (100%), polypharmacy (100%), basic function (93%), mobility (86%), falls risk (71%), frailty (64%), and cognition (57%). Sensory impairment (50%), social isolation (50%), nutritional status (43%), loneliness (7%), and financial means (7%) were least frequently assessed. There was significant heterogeneity with regard to the tools used to assess subdomains. Common themes for how the subdomains influenced clinical care included informing prognosis, informing risk-benefit of pharmacologic therapy and invasive procedures, and consideration for palliative care. CONCLUSIONS: While respondents routinely assess multiple domains and subdomains and view these as important to clinical care, there is substantial heterogeneity regarding which subdomains are assessed and the tools used to assess them. These observations provide a foundation that inform a research agenda with regard to providing holistic and patient-centered care to older adults with HF. J Am Geriatr Soc 67:2593-2599, 2019.
BACKGROUND/ OBJECTIVES: The American College of Cardiology (ACC) Geriatric Cardiology Section Leadership Council recently outlined 4 key domains (which are composed of 14 subdomains) that are important to assess in older adults with heart failure (HF). We sought to determine which geriatric domains/subdomains are routinely assessed, how they are assessed, and how they impact clinical management in the care of ambulatory older adults with HF. DESIGN: Survey. SETTING: Ambulatory. PARTICIPANTS: Fifteen active ACC member physicians from the geriatric cardiology community. MEASUREMENTS: Electronic survey assessing which domains/subdomains are currently assessed in these selected real-world practices, how they are assessed, and how they are incorporated into clinical management. RESULTS: Of 15 clinicians, 14 responded to the survey. The majority routinely assess 3 to 4 domains (median, 3; interquartile range, 3-4) and a range of 4 to 12 subdomains (median, 8; interquartile range, 6-11). All respondents routinely assess the medical and physical function domains, 71% routinely assess the mind/emotion domain, and 50% routinely assess the social domain. The most common subdomains included comorbidity burden (100%), polypharmacy (100%), basic function (93%), mobility (86%), falls risk (71%), frailty (64%), and cognition (57%). Sensory impairment (50%), social isolation (50%), nutritional status (43%), loneliness (7%), and financial means (7%) were least frequently assessed. There was significant heterogeneity with regard to the tools used to assess subdomains. Common themes for how the subdomains influenced clinical care included informing prognosis, informing risk-benefit of pharmacologic therapy and invasive procedures, and consideration for palliative care. CONCLUSIONS: While respondents routinely assess multiple domains and subdomains and view these as important to clinical care, there is substantial heterogeneity regarding which subdomains are assessed and the tools used to assess them. These observations provide a foundation that inform a research agenda with regard to providing holistic and patient-centered care to older adults with HF. J Am Geriatr Soc 67:2593-2599, 2019.
Authors: Ashok Krishnaswami; Michael A Steinman; Parag Goyal; Andrew R Zullo; Timothy S Anderson; Kim K Birtcher; Sarah J Goodlin; Mathew S Maurer; Karen P Alexander; Michael W Rich; Jennifer Tjia Journal: J Am Coll Cardiol Date: 2019-05-28 Impact factor: 24.094
Authors: Jonathan Afilalo; Sandra Lauck; Dae H Kim; Thierry Lefèvre; Nicolo Piazza; Kevin Lachapelle; Giuseppe Martucci; Andre Lamy; Marino Labinaz; Mark D Peterson; Rakesh C Arora; Nicolas Noiseux; Andrew Rassi; Igor F Palacios; Philippe Généreux; Brian R Lindman; Anita W Asgar; Caroline A Kim; Amanda Trnkus; José A Morais; Yves Langlois; Lawrence G Rudski; Jean-Francois Morin; Jeffrey J Popma; John G Webb; Louis P Perrault Journal: J Am Coll Cardiol Date: 2017-07-07 Impact factor: 24.094
Authors: Zachary A Marcum; Megan E Amuan; Joseph T Hanlon; Sherrie L Aspinall; Steven M Handler; Christine M Ruby; Mary Jo V Pugh Journal: J Am Geriatr Soc Date: 2011-12-08 Impact factor: 5.562
Authors: Bernd Löwe; Oliver Decker; Stefanie Müller; Elmar Brähler; Dieter Schellberg; Wolfgang Herzog; Philipp Yorck Herzberg Journal: Med Care Date: 2008-03 Impact factor: 2.983
Authors: Kristine E Ensrud; Susan K Ewing; Brent C Taylor; Howard A Fink; Peggy M Cawthon; Katie L Stone; Teresa A Hillier; Jane A Cauley; Marc C Hochberg; Nicolas Rodondi; J Kathleen Tracy; Steven R Cummings Journal: Arch Intern Med Date: 2008-02-25
Authors: Eiran Z Gorodeski; Parag Goyal; Scott L Hummel; Ashok Krishnaswami; Sarah J Goodlin; Linda L Hart; Daniel E Forman; Nanette K Wenger; James N Kirkpatrick; Karen P Alexander Journal: J Am Coll Cardiol Date: 2018-05-01 Impact factor: 24.094
Authors: Ambarish Pandey; Muthiah Vaduganathan; Sameer Arora; Arman Qamar; Robert J Mentz; Sanjiv J Shah; Patricia P Chang; Stuart D Russell; Wayne D Rosamond; Melissa C Caughey Journal: Circulation Date: 2020-06-03 Impact factor: 29.690
Authors: Lina M Brinker; Matthew C Konerman; Pedram Navid; Michael P Dorsch; Jennifer McNamara; Cristen J Willer; Mary E Tinetti; Scott L Hummel; Parag Goyal Journal: Am J Med Date: 2020-08-18 Impact factor: 4.965
Authors: Julia H I Wiersinga; Hanneke F M Rhodius-Meester; Emma E F Kleipool; Louis Handoko; Albert C van Rossum; Su-San Liem; Marijke C Trappenburg; Mike J L Peters; Majon Muller Journal: ESC Heart Fail Date: 2021-04-08
Authors: Parag Goyal; Brian Yum; Pedram Navid; Ligong Chen; Dae H Kim; Jason Roh; Byron C Jaeger; Emily B Levitan Journal: Am J Cardiol Date: 2021-03-03 Impact factor: 3.133
Authors: Ozan Unlu; Emily B Levitan; Evgeniya Reshetnyak; Jerard Kneifati-Hayek; Ivan Diaz; Alexi Archambault; Ligong Chen; Joseph T Hanlon; Mathew S Maurer; Monika M Safford; Mark S Lachs; Parag Goyal Journal: Circ Heart Fail Date: 2020-10-13 Impact factor: 8.790