Prioritizing Functional Capacity as a Principal End Point for Therapies Oriented to Older Adults with Cardiovascular Disease: A Scientific Statement for Healthcare Professionals from the American Heart Association

Daniel E. Forman, Ross Arena, Rebecca Boxer, Mary A. Dolansky, Janice J. Eng, Jerome L. Fleg, Mark Haykowsky, Arshad Jahangir, Leonard A. Kaminsky, Dalane W. Kitzman, Eldrin F. Lewis, Jonathan Myers, Gordon R. Reeves, Win Kuang Shen, American Heart Association Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Quality of Care and Outcomes Research, Stroke Council

Research output: Contribution to journalReview article

56 Citations (Scopus)

Abstract

Adults are living longer, and cardiovascular disease is endemic in the growing population of older adults who are surviving into old age. Functional capacity is a key metric in this population, both for the perspective it provides on aggregate health and as a vital goal of care. Whereas cardiorespiratory function has long been applied by cardiologists as a measure of function that depended primarily on cardiac physiology, multiple other factors also contribute, usually with increasing bearing as age advances. Comorbidity, inflammation, mitochondrial metabolism, cognition, balance, and sleep are among the constellation of factors that bear on cardiorespiratory function and that become intricately entwined with cardiovascular health in old age. This statement reviews the essential physiology underlying functional capacity on systemic, organ, and cellular levels, as well as critical clinical skills to measure multiple realms of function (eg, aerobic, strength, balance, and even cognition) that are particularly relevant for older patients. Clinical therapeutic perspectives and patient perspectives are enumerated to clarify challenges and opportunities across the caregiving spectrum, including patients who are hospitalized, those managed in routine office settings, and those in skilled nursing facilities. Overall, this scientific statement provides practical recommendations and vital conceptual insights.

Original languageEnglish (US)
Pages (from-to)e894-e918
JournalCirculation
Volume135
Issue number16
DOIs
StatePublished - Apr 18 2017
Externally publishedYes

Fingerprint

Cardiovascular Diseases
Delivery of Health Care
Cognition
Skilled Nursing Facilities
Patient Care Planning
Clinical Competence
Health
Population
Comorbidity
Sleep
Therapeutics
Inflammation
Cardiologists

Keywords

  • aged
  • AHA Scientific Statements
  • cardiopulmonary exercise test
  • cardiorespiratory fitness
  • exercise tolerance
  • frail older adults
  • physical activity
  • sarcopenia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Prioritizing Functional Capacity as a Principal End Point for Therapies Oriented to Older Adults with Cardiovascular Disease : A Scientific Statement for Healthcare Professionals from the American Heart Association. / Forman, Daniel E.; Arena, Ross; Boxer, Rebecca; Dolansky, Mary A.; Eng, Janice J.; Fleg, Jerome L.; Haykowsky, Mark; Jahangir, Arshad; Kaminsky, Leonard A.; Kitzman, Dalane W.; Lewis, Eldrin F.; Myers, Jonathan; Reeves, Gordon R.; Shen, Win Kuang; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; Stroke Council.

In: Circulation, Vol. 135, No. 16, 18.04.2017, p. e894-e918.

Research output: Contribution to journalReview article

Forman, DE, Arena, R, Boxer, R, Dolansky, MA, Eng, JJ, Fleg, JL, Haykowsky, M, Jahangir, A, Kaminsky, LA, Kitzman, DW, Lewis, EF, Myers, J, Reeves, GR, Shen, WK, American Heart Association Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Quality of Care and Outcomes Research & Stroke Council 2017, 'Prioritizing Functional Capacity as a Principal End Point for Therapies Oriented to Older Adults with Cardiovascular Disease: A Scientific Statement for Healthcare Professionals from the American Heart Association', Circulation, vol. 135, no. 16, pp. e894-e918. https://doi.org/10.1161/CIR.0000000000000483
Forman, Daniel E. ; Arena, Ross ; Boxer, Rebecca ; Dolansky, Mary A. ; Eng, Janice J. ; Fleg, Jerome L. ; Haykowsky, Mark ; Jahangir, Arshad ; Kaminsky, Leonard A. ; Kitzman, Dalane W. ; Lewis, Eldrin F. ; Myers, Jonathan ; Reeves, Gordon R. ; Shen, Win Kuang ; American Heart Association Council on Clinical Cardiology ; Council on Cardiovascular and Stroke Nursing ; Council on Quality of Care and Outcomes Research ; Stroke Council. / Prioritizing Functional Capacity as a Principal End Point for Therapies Oriented to Older Adults with Cardiovascular Disease : A Scientific Statement for Healthcare Professionals from the American Heart Association. In: Circulation. 2017 ; Vol. 135, No. 16. pp. e894-e918.
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