چکیده (انگلیسی):

Background:Clinical care for older adults is complex and represents a growing problem. They are a diverse patient
group with varying needs, frequent presence of multiple comorbidities, and are more susceptible to treatment
harms. Thus Clinical Practice Guidelines (CPGs) need to carefully consider older adults in order to guide clinicians.
We reviewed CPG recommendations for primary cardiovascular disease (CVD) prevention and examined the extent
to which CPGs address issues important for older people identified in the literature.
Methods:We searched: 1) two systematic reviews on CPGs for CVD prevention and 2) the National CPG
Clearinghouse, G-I-N International CPG Library and Trip databases for CPGs for CVD prevention, hypertension and
cholesterol. We conducted our search between April and December 2013. We excluded CPGs for diabetes, chronic
kidney disease, HIV, lifestyle, general screening/prevention, and pregnant or pediatric populations. Three authors
independently screened citations for inclusion and extracted data. The primary outcomes were presence and extent
of recommendations for older people including discussion of: (1) available evidence, (2) barriers to implementation
of the CPG, and (3) tailoring management for this group.
Results:We found 47 eligible CPGs. There was no mention of older people in 4 (9 %) of the CPGs. Benefits were
discussed more frequently than harms. Twenty-three CPGs (49 %) discussed evidence about potential benefits and
18 (38 %) discussed potential harms of CVD prevention in older people. Most CPGs addressed one or more barriers
to implementation, often as a short statement. Although 27 CPGs (58 %) mentioned tailoring management to the
older patient context (e.g. comorbidities), concrete guidance was rare.
Conclusion:Although most CVD prevention CPGs mention the older population to some extent, the information
provided is vague and very limited. Older adults represent a growing proportion of the population. Guideline
developers must ensure they consider older patients’ needs and provide appropriate advice to clinicians in order to
support high quality care for this group. CPGs should at a minimum address the available evidence about CVD
prevention for older people, and acknowledge the importance of patient involvement.