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ObjectivesTo identify the top priority areas for research to optimize pharmacotherapy in older adults with cardiovascular disease (CVD).DesignConsensus meeting.SettingMultidisciplinary workshop supported by the National Institute on Aging, the American College of Cardiology, and the American Geriatrics Society, February 6-7, 2017.ParticipantsLeaders in the Cardiology and Geriatrics communities, (officers in professional societies, journal editors, clinical trialists, Division chiefs), representatives from the NIA; National Heart, Lung, and Blood Institute; Food and Drug Administration; Centers for Medicare and Medicaid Services, Alliance for Academic Internal Medicine, Patient-Centered Outcomes Research Institute, Agency for Healthcare Research and Quality, pharmaceutical industry, and trainees and early career faculty with interests in geriatric cardiology.MeasurementsSummary of workshop proceedings and recommendations.ResultsTo better align older adults' healthcare preferences with their care, research is needed to improve skills in patient engagement and communication. Similarly, to coordinate and meet the needs of older adults with multiple comorbidities encountering multiple healthcare providers and systems, systems and disciplines must be integrated. The lack of data from efficacy trials of CVD medications relevant to the majority of older adults creates uncertainty in determining the risks and benefits of many CVD therapies; thus, developing evidence-based guidelines for older adults with CVD is a top research priority. Polypharmacy and medication nonadherence lead to poor outcomes in older people, making research on appropriate prescribing and deprescribing to reduce polypharmacy and methods to improve adherence to beneficial therapies a priority.ConclusionThe needs and circumstances of older adults with CVD differ from those that the current medical system has been designed to meet. Optimizing pharmacotherapy in older adults will require new data from traditional and pragmatic research to determine optimal CVD therapy, reduce polypharmacy, increase adherence, and meet person-centered goals. Better integration of the multiple systems and disciplines involved in the care of older adults will be essential to implement and disseminate best practices. J Am Geriatr Soc 67:371-380, 2019.

Background: Evidence on overall survival (OS) with cyclin‐dependent kinase 4 and 6 (CDK4/6) inhibitors is generally limited to data from clinical trials or a few observational studies with limited generalizability to Medicare population. The aim of this study was to determine OS benefits associated with CDK4/6 inhibitors in older Medicare patients with hormone receptor (HR)–positive and human epidermal growth factor receptor‐2 overexpressing (HER2–) metastatic breast cancer (MBC). Methods: In a retrospective cohort design, female patients aged ≥65 years with diagnosis of HR+/HER2– MBC from 2015 to 2017 who initiated first‐line systemic therapy within 12 months of MBC diagnosis were selected from the Survey Epidemiology and End Results‐Medicare database. The effect of treatment type (endocrine therapy [ET]+CDK4/6 inhibitor vs. ET alone) on OS was analyzed using Kaplan–Meier methods and multivariable Cox regression models. Adjusted hazard ratio (aHR) and 95% CIs were estimated. Results: A total of 630 eligible patients were identified (169 patients treated with ET+CDK4/6 inhibitor and 461 patients treated with ET alone). In the Kaplan–Meier analysis, OS rate at 3 years after first‐line treatment initiation was 73.0% for ET+CDK4/6 inhibitor versus 49.1% for ET alone (log‐rank p <.0001). In Cox regression analysis, first‐line ET+CDK4/6 inhibitor therapy was associated with 41% lower rate of mortality versus ET alone (aHR, 0.590; 95% CI, 0.423–0.823). Conclusions: The findings of this real‐world study demonstrate significant OS benefit associated with ET+CDK4/6 inhibitor therapy over ET alone in an older Medicare population of patients with HR+/HER2– MBC, largely consistent with the evidence from clinical trials. In patients with metastatic breast cancer (MBC) receiving treatment with cyclin‐dependent kinase 4 and 6 (CDK4/6) inhibitors, evidence on overall survival is generally limited to data from clinical trials or observational studies not generalizable to patients in the Medicare population. The findings of this real‐world analysis demonstrate that the addition of CDK4/6 inhibitors to endocrine therapy (ET) significantly improved survival among older Medicare beneficiaries, suggesting that treatment with ET alone should have a limited role in early lines of therapy for Medicare patients with HR+/HER2– MBC. [ABSTRACT FROM AUTHOR]

Background Polypharmacy is one factor contributing to increased mortality, hospitalization, and adverse drug reactions in older adults. The aim of this study was to measure the prevalence of polypharmacy in a cohort of older women with early-stage operable primary breast cancer and the relationship of polypharmacy to primary treatment decision and functional status. Methods A total of 139 patients with a new diagnosis of early-stage operable primary breast cancer proven histologically were recruited as part of a prospective study. The average age was 77 years. Assessment using a cancer-specific Comprehensive Geriatric Assessment (CGA) tool was conducted within 6 weeks of diagnosis of breast cancer. Association was determined between number of medications and treatment decision and physical status as measured by the CGA outcomes. Additional analysis was performed to determine the associations above with polypharmacy defined by ≥5 daily medications, and if cardiovascular-related diseases have a role in the treatment decision. Results Polypharmacy was present in 48% of patients (n = 139). CGA determined that polypharmacy was associated with greater comorbidity (P <.001), reduced physical status rated by physicians (P =.009) and patients (P =.019), and reduced ability to perform activities of instrumental ADLs (P =.008). Similar findings were present in the analysis of cardiovascular-related diseases. Conclusions This work suggests that patients with polypharmacy are more likely to be frail. The number of medications could help us screen patients who should go on to receive full CGA. [ABSTRACT FROM AUTHOR]