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2. Succeeding in Aging Research During the Pandemic: Strategies for Fellows and Junior Faculty

Author

Cohen, Andrew B, Parks, Anna L, Whitson, Heather E, Zieman, Susan, Brown, Cynthia J, Boyd, Cynthia, Covinsky, Kenneth E, and Steinman, Michael A

Subjects
Biomedical and Clinical Sciences, Health Sciences, Psychology, Aging, COVID-19, Career Mobility, Faculty, Medical, Fellowships and Scholarships, Geriatrics, Humans, Medical Staff, Hospital, Research Personnel, SARS-CoV-2, aging research, early-career researchers, junior faculty, Medical and Health Sciences, Biomedical and clinical sciences, Health sciences
Abstract

Fellows and junior faculty conducting aging research have encountered substantial new challenges during the COVID-19 pandemic. They report that they have been uncertain how and whether to modify existing research studies, have faced difficulties with job searches, and have struggled to balance competing pressures including greater clinical obligations and increased responsibilities at home. Many have also wondered if they should shift gears and make COVID-19 the focus of their research. We asked a group of accomplished scientists and mentors to grapple with these concerns and to share their thoughts with readers of this journal.

Published
2021

3. Cardiovascular Biomarkers and Imaging in Older Adults JACC Council Perspectives

Author

Forman, Daniel E, de Lemos, James A, Shaw, Leslee J, Reuben, David B, Lyubarova, Radmila, Peterson, Eric D, Spertus, John A, Zieman, Susan, Salive, Marcel E, Rich, Michael W, and Council, Geriatric Cardiology Section Leadership

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Aging, Cardiovascular, Heart Disease, 4.1 Discovery and preclinical testing of markers and technologies, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, Good Health and Well Being, Aged, Biomarkers, Cardiac Imaging Techniques, Exercise Test, Humans, aging, biomarkers, cardiovascular testing, imaging, shared decision making, stress testing, Geriatric Cardiology Section Leadership Council, Cardiorespiratory Medicine and Haematology, Public Health and Health Services, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

Whereas the burgeoning population of older adults is intrinsically vulnerable to cardiovascular disease, the utility of many management precepts that were validated in younger adults is often unclear. Whereas biomarker- and imaging-based tests are a major part of cardiovascular disease care, basic assumptions about their use and efficacy cannot be simply extrapolated to many older adults. Biology, physiology, and body composition change with aging, with important influences on cardiovascular disease testing procedures and their interpretation. Furthermore, clinical priorities of older adults are more heterogeneous, potentially undercutting the utility of testing data that are collected. The American College of Cardiology and the National Institutes on Aging, in collaboration with the American Geriatrics Society, convened, at the American College of Cardiology Heart House, a 2-day multidisciplinary workshop, "Diagnostic Testing in Older Adults with Cardiovascular Disease," to address these issues. This review summarizes key concepts, clinical limitations, and important opportunities for research.

Published
2020

4. Research Opportunities in Stroke Prevention for Atrial Fibrillation: A Report From a National Heart, Lung, and Blood Institute Virtual Workshop

Author

Go, Alan S., Al-Khatib, Sana M., Desvigne-Nickens, Patrice, Bansal, Nisha, Bushnell, Cheryl D., Fang, Margaret C., Freeman, James V., Gage, Brian F., Hanke, Thorsten, Hylek, Elaine M., Lopes, Renato D., Noseworthy, Peter A., Reddy, Vivek Y., Singer, Daniel E., Thomas, Kevin L., True Hills, Mellanie, Turakhia, Mintu P., Zieman, Susan J., Cooper, Lawton S., and Benjamin, Emelia J.

Published
2023
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5. Multimorbidity in Older Adults With Cardiovascular Disease

Author

Forman, Daniel E, Maurer, Mathew S, Boyd, Cynthia, Brindis, Ralph, Salive, Marcel E, Horne, Frances McFarland, Bell, Susan P, Fulmer, Terry, Reuben, David B, Zieman, Susan, and Rich, Michael W

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Behavioral and Social Science, Clinical Research, Heart Disease, Cardiovascular, Aging, Management of diseases and conditions, 7.3 Management and decision making, Generic health relevance, Good Health and Well Being, Age Factors, Aged, Aged, 80 and over, Cardiovascular Diseases, Clinical Decision-Making, Humans, Kidney Diseases, Mental Disorders, Multimorbidity, aging, frailty, multimorbidity, polypharmacy, quality of life, Cardiorespiratory Medicine and Haematology, Public Health and Health Services, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

Multimorbidity occurs in adults of all ages, but the number and complexity of comorbid conditions commonly increase with advancing age such that cardiovascular disease (CVD) in older adults typically occurs in a context of multimorbidity. Current clinical practice and research mainly target single disease-specific care that does not embrace the complexities imposed by concurrent conditions. In this paper, emerging concepts regarding CVD in combination with multimorbidity are reviewed, including recommendations for incorporating multimorbidity into clinical decision making, critical knowledge gaps, and research priorities to optimize care of complex older patients.

Published
2018

6. Aging, the Medical Subspecialties, and Career Development: Where We Were, Where We Are Going

Author

Hurria, Arti, High, Kevin P, Mody, Lona, Horne, Frances McFarland, Escobedo, Marcus, Halter, Jeffrey, Hazzard, William, Schmader, Kenneth, Klepin, Heidi, Lee, Sei, Makris, Una E, Rich, Michael W, Rogers, Stephanie, Wiggins, Jocelyn, Watman, Rachael, Choi, Jennifer, Lundebjerg, Nancy, and Zieman, Susan

Subjects
Health Services and Systems, Health Sciences, Health Services, Clinical Research, Aging, Patient Safety, Aged, Biomedical Research, Career Mobility, Geriatrics, Humans, Medicine, Societies, Medical, United States, geriatrics, medical subspecialties, aging research, Medical and Health Sciences, Biomedical and clinical sciences, Health sciences, Psychology
Abstract

Historically, the medical subspecialties have not focused on the needs of older adults. This has changed with the implementation of initiatives to integrate geriatrics and aging research into the medical and surgical subspecialties and with the establishment of a home for internal medicine specialists within the annual American Geriatrics Society (AGS) meeting. With the support of AGS, other professional societies, philanthropies, and federal agencies, efforts to integrate geriatrics into the medical and surgical subspecialties have focused largely on training the next generation of physicians and researchers. They have engaged several subspecialties, which have followed parallel paths in integrating geriatrics and aging research. As a result of these combined efforts, there has been enormous progress in the integration of geriatrics and aging research into the medical and surgical subspecialties, and topics once considered to be geriatric concerns are becoming mainstream in medicine, but this integration remains a work in progress and will need to adapt to changes associated with healthcare reform.

Published
2017

7. Cardiovascular physiology in the older adults

Author

Dai, Xuming, Hummel, Scott L, Salazar, Jorge B, Taffet, George E, Zieman, Susan, and Schwartz, Janice B

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Aging, Cardiovascular disease, Left ventricular, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Published
2015

9. Serum Carboxymethyl-Lysine, Disability, and Frailty in Older Persons: The Cardiovascular Health Study

Author

Whitson, Heather E, Arnold, Alice M, Yee, Laura M, Mukamal, Kenneth J, Kizer, Jorge R, Djousse, Luc, Ix, Joachim H, Siscovick, David, Tracy, Russell P, Thielke, Stephen M, Hirsch, Calvin, Newman, Anne B, and Zieman, Susan

Subjects
Epidemiology, Biomedical and Clinical Sciences, Health Sciences, Clinical Research, Rehabilitation, Aging, Activities of Daily Living, Aged, Aged, 80 and over, Biomarkers, Cardiac Rehabilitation, Cardiovascular Diseases, Disabled Persons, Female, Follow-Up Studies, Frail Elderly, Health Status, Humans, Incidence, Lysine, Male, Prevalence, Prognosis, Retrospective Studies, United States, Disablement process, Frailty, Metabolism, Metabolism., Clinical Sciences, Gerontology, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundAdvanced glycation endproducts are biologically active compounds that accumulate in disordered metabolism and normal aging. Carboxymethyl-lysine (CML), a ubiquitous human advanced glycation endproduct, has been associated with age-related conditions and mortality. Our objective was to ascertain the relationship between CML and geriatric outcomes (disability and frailty) in a large cohort of older men and women.MethodsIn 1996-1997, serum CML was measured in 3,373 Cardiovascular Health Study participants (mean age 78.1 ± 4.8 years). Disability, defined as difficulty in any of six activities of daily living, was assessed every 6-12 months for 14 years. Frailty was defined according to five standard criteria at the 1996-1997 visit. Cox proportional hazard models estimated the relationship between CML and incident disability (N = 2,643). Logistic regression models estimated the relationship between CML and prevalent frailty.ResultsAdjusting for multiple potential confounders, higher CML was associated with incident disability (hazard ratio per standard deviation [225 ng/mL] increase: 1.05, 95% CI 1.01-1.11). In men, odds of frailty increased with higher CML values (odds ratio = 1.30 per standard deviation, 95% CI 1.14-1.48), but the relationship was attenuated by adjustment for cognitive status, kidney function, and arthritis. CML was not associated with frailty in women.ConclusionsHigher serum CML levels in late life are associated with incident disability and prevalent frailty. Further work is needed to understand CML's value as a risk stratifier, biomarker, or target for interventions that promote healthy aging.

Published
2014

11. Research Needs and Priorities for Catheter Ablation of Atrial Fibrillation: A Report From a National Heart, Lung, and Blood Institute Virtual Workshop

Author

Al-Khatib, Sana M., Benjamin, Emelia J., Buxton, Alfred E., Calkins, Hugh, Chung, Mina K., Curtis, Anne B., Desvigne-Nickens, Patrice, Jais, Pierre, Packer, Douglas L., Piccini, Jonathan P., Rosenberg, Yves, Russo, Andrea M., Wang, Paul J., Cooper, Lawton S., Go, Alan S., Healey, Jeff S., Link, Mark S., Marrouche, Nassir F., Noseworthy, Peter A., Sanders, Prashanthan, Hills, Melanie True, Yao, Xiaoxi, and Zieman, Susan J.

Published
2020
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12. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Author

Amsterdam, Ezra A., Wenger, Nanette K., Brindis, Ralph G., Casey, Donald E., Jr., Ganiats, Theodore G., Holmes, David R., Jr., Jaffe, Allan S., Jneid, Hani, Kelly, Rosemary F., Kontos, Michael C., Levine, Glenn N., Liebson, Philip R., Mukherjee, Debabrata, Peterson, Eric D., Sabatine, Marc S., Smalling, Richard W., and Zieman, Susan J.

Published
2014
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13. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Author

Amsterdam, Ezra A., Wenger, Nanette K., Brindis, Ralph G., Casey, Donald E., Jr., Ganiats, Theodore G., Holmes, David R., Jr., Jaffe, Allan S., Jneid, Hani, Kelly, Rosemary F., Kontos, Michael C., Levine, Glenn N., Liebson, Philip R., Mukherjee, Debabrata, Peterson, Eric D., Sabatine, Marc S., Smalling, Richard W., and Zieman, Susan J.

Published
2014
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19. Ischemic Heart Disease

Author

Zieman, Susan J., Schulman, Steven P., Fleg, Jerome L., Cannon, Christopher P., editor, Edwards, Niloo M., editor, Maurer, Mathew S., editor, and Wellner, Rachel B., editor

Published
2003
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20. Integrating Frailty Research into the Medical Specialties—Report from a U13 Conference

Author

Walston, Jeremy, Robinson, Thomas N., Zieman, Susan, McFarland, Frances, Carpenter, Christopher R., Althoff, Keri N., Andrew, Melissa K., Blaum, Caroline S., Brown, Patrick J., Buta, Brian, Ely, E. Wesley, Ferrucci, Luigi, High, Kevin P., Kritchevsky, Stephen B., Rockwood, Kenneth, Schmader, Kenneth E., Sierra, Felipe, Sink, Kaycee M., Varadhan, Ravi, and Hurria, Arti

Published
2017
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25. Update on RFA Increasing Use of Cardiac and Pulmonary Rehabilitation in Traditional and Community Settings NIH-Funded Trials

Author

Shero, Susan T., primary, Benzo, Roberto, additional, Cooper, Lawton S., additional, Finkelstein, Joseph, additional, Forman, Daniel E., additional, Gaalema, Diann E., additional, Joseph, Lyndon, additional, Keteyian, Steven J., additional, Peterson, Pamela N., additional, Punturieri, Antonello, additional, Zieman, Susan, additional, and Fleg, Jerome L., additional

Published
2021
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28. Chronic Wound Repair and Healing in Older Adults: Current Status and Future Research

Author

Gould, Lisa, Abadir, Peter, Brem, Harold, Carter, Marissa, Conner-Kerr, Teresa, Davidson, Jeff, DiPietro, Luisa, Falanga, Vincent, Fife, Caroline, Gardner, Sue, Grice, Elizabeth, Harmon, John, Hazzard, William R., High, Kevin P., Houghton, Pamela, Jacobson, Nasreen, Kirsner, Robert S., Kovacs, Elizabeth J., Margolis, David, McFarland Horne, Frances, Reed, May J., Sullivan, Dennis H., Thom, Stephen, Tomic-Canic, Marjana, Walston, Jeremy, Whitney, Jo Anne, Williams, John, Zieman, Susan, and Schmader, Kenneth

Published
2015
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29. Abstract P018: Advanced Glycation End Products And And Incident Cardiovascular Disease

Author

Lamprea-montealegre, Julio A, primary, Arnold, Alice, additional, McClelland, Robyn, additional, Tracy, Russell P, additional, Djousse, Luc, additional, Mukamal, Kenneth J, additional, Psaty, Bruce M, additional, Siscovick, David S, additional, Zieman, Susan J, additional, Brownlee, Michael, additional, Biggs, Mary Lou, additional, Beisswenger, Paul J, additional, Ix, Joachim H, additional, and Kizer, Jorge R, additional

Published
2021
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38. Reviewers

Author

Bienstock, Jessica L., primary, Cohen, Bernard A., additional, Cooper, Lisa A., additional, Gearhart, John P., additional, Giardiello, Francis M., additional, Hesdorffer, Charles, additional, Kinney, Leanna, additional, Llinas, Rafael H., additional, McCambridge, Teri, additional, Ratchford, Elizabeth, additional, Riley, Reed D., additional, Scheel, Janet, additional, Schwartz, Amy Kathryn, additional, Sosnay, Patrick R., additional, Zieman, Susan J., additional, Hopkins, Hollis, additional, Medina, Crystal, additional, and Wu, James, additional

Published
2011
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47. Statins for Primary Prevention in Older Adults-Moving Toward Evidence-Based Decision-Making

Author

Singh, Sonal, Zieman, Susan, Go, Alan S., Fortmann, Stephen P., Wenger, Nanette K., Fleg, Jerome L., Radziszewska, Barbara, Stone, Neil J., Zoungas, Sophia, and Gurwitz, Jerry H.

Subjects
Primary Prevention, Decision Making, Diabetes Mellitus, Humans, Cognitive Dysfunction, Comorbidity, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Atherosclerosis, Article, Aged, Education
Abstract

OBJECTIVES: To determine the efficacy and safety of statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) events in older adults, especially those aged 80 and older and with multimorbidity. METHODS: The National Institute on Aging and the National Heart, Lung and Blood Institute convened A multidisciplinary expert panel from July 31 to August 1, 2017, to review existing evidence, identify knowledge gaps, and consider whether statin safety and efficacy data in persons aged 75 and older without ASCVD are sufficient; whether existing data can inform the feasibility, design, and implementation of future statin trials in older adults; and clinical trial options and designs to address knowledge gaps. This article summarizes the presentations and discussions at that workshop. RESULTS: There is insufficient evidence regarding the benefits and harms of statins in older adults, especially those with concomitant frailty, polypharmacy, comorbidities, and cognitive impairment; a lack of tools to assess ASCVD risk in those aged 80 and older; and a paucity of evidence of the effect of statins on outcomes of importance to older adults, such as statin-associated muscle symptoms, cognitive function, and incident diabetes mellitus. Prospective, traditional, placebo-controlled, randomized clinical trials (RCTs) and pragmatic RCTs seem to be suitable options to address these critical knowledge gaps. Future trials have to consider greater representation of very old adults, women, underrepresented minorities, and individuals of differing health, cognitive, socioeconomic, and educational backgrounds. Feasibility analyses from existing large healthcare networks confirm appropriate power for death and cardiovascular outcomes for future RCTs in this area. CONCLUSION: Existing data cannot address uncertainties about the benefits and harms of statins for primary ASCVD prevention in adults aged 75 and older, especially those with comorbidities, frailty, and cognitive impairment. Evidence from 1 or more RCTs could address these important knowledge gaps to inform person-centered decision-making.

Published
2018

50. Pathways, Contributors, and Correlates of Functional Limitation Across Specialties: Workshop Summary

Author

Kritchevsky, Stephen B, primary, Forman, Daniel E, additional, Callahan, Kathryn E, additional, Ely, E Wesley, additional, High, Kevin P, additional, McFarland, Frances, additional, Pérez-Stable, Eliseo J, additional, Schmader, Kenneth E, additional, Studenski, Stephanie A, additional, Williams, John, additional, Zieman, Susan, additional, and Guralnik, Jack M, additional

Published
2018
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