{"id":7258,"date":"2011-03-30T05:35:50","date_gmt":"2011-03-30T09:35:50","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=7258"},"modified":"2011-07-19T17:44:29","modified_gmt":"2011-07-19T21:44:29","slug":"many-elderly-patients-excluded-from-heart-failure-trials","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/03\/30\/many-elderly-patients-excluded-from-heart-failure-trials\/","title":{"rendered":"Many Elderly Patients Excluded from Heart Failure Trials"},"content":{"rendered":"<p>Despite the large and growing burden of heart failure in the elderly   population, older people are often excluded from heart failure clinical  trials. In <a href=\"http:\/\/archinte.ama-assn.org\/cgi\/content\/full\/171\/6\/550\">a  paper in the <em>Archives of Internal Medicine<\/em><\/a>, Antonio Cherubini and  colleagues\u00a0 examined 251 heart failure trials and found that a quarter  of the trials excluded patients by an arbitrary upper age limit, while  43% included poorly justified exclusion criteria that might have reduced  the number of older subjects.<\/p>\n<p>The authors write that &#8220;the discrepancy between the patients  evaluated in most&#8221; clinical trials and the real world patient population  &#8220;is particularly marked in the field of HF, a condition common in older  age.&#8221; They observe that only a relatively small number of elderly  hospitalized HF patients would have been eligible for the landmark  clinical trials that established the current standard of care for these  patients.<\/p>\n<p>In<a href=\"http:\/\/archinte.ama-assn.org\/cgi\/content\/full\/171\/6\/557\"> an  accompanying commentary<\/a>, Jerry Gurwitz and Robert Goldberg propose  several initial steps to improve the evidence base of care for older  heart patients:<\/p>\n<ol>\n<li>&#8220;Eliminate arbitrary age-based exclusions in cardiovascular clinical  trials;<\/li>\n<li>&#8220;Require strong justification for exclusion criteria that could  adversely affect the inclusion of older individuals, including those  criteria relating to comorbidity, medication use, and functional and  cognitive impairment;<\/li>\n<li>&#8220;Encourage the design and conduct of RCTs specific to older  individuals through targeted funding; and<\/li>\n<li>&#8220;Report and publicize trends in the inclusion of elderly patients in  cardiovascular clinical trials to assess progress in improving the  generalizability of research findings to this high-risk population.&#8221;<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Despite the large and growing burden of heart failure in the elderly population, older people are often excluded from heart failure clinical trials. In a paper in the Archives of Internal Medicine, Antonio Cherubini and colleagues\u00a0 examined 251 heart failure trials and found that a quarter of the trials excluded patients by an arbitrary upper [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14],"tags":[763,508,287,764],"class_list":["post-7258","post","type-post","status-publish","format-standard","hentry","category-heart-failure","tag-age","tag-clinical-trials","tag-heart-failure-2","tag-older-patients"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/7258","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=7258"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/7258\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=7258"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=7258"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=7258"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}