Unmet Needs

Use your clinical experience to identify unmet needs for older adults with cardiovascular disease and help us advance the field of geriatric cardiology.

 

GNYGCC is committed to playing a role in the development of solutions that address limitations in the cardiovascular care of the elderly. This involves each of us identifying important clinical problems that exist in the care of the older adult and articulating them as Unmet Needs. The idea of Unmet Needs is an integral part of the Stanford Biodesign Program. The articulation of an Unmet Need serves as the foundation upon which to fully understand a clinical problem in order to subsequently develop approaches and solutions that are likely to successfully address the problem.

Needs – which represent the change in outcome or practice that is required to address a defined clinical problem – may be thought of as the bridge between problems and solutions. Far too often, clever innovations fail because they have not been developed to address “real” patient and/or market needs. Once a need is clearly articulated, the most important parameters or criteria that will guide the design and development of the solution can be defined. Concepts and potential solutions can then be evaluated against these criteria to ensure that they effectively meet the clinical need.

Need statements articulate the problem and the change in outcome that is required to satisfy the clinical dilemma. Importantly, a need should not address how the change in outcome will be accomplished – rather, the need should be focused solely on defining what change in outcome is required to resolve the stated problem.

Everyone involved in the care of older adults with cardiovascular disorders has unique and valuable information about the shortcomings of that care. When we work together to identify common gaps in care, and focus our clinical experience and understanding to determine whether there are outcomes that can be improved, we begin down the path of identifying Unmet Needs. Rather than trying to identify technologies that appear promising and only then trying to find problems they may address, we intend to follow the more rational and likely more fruitful approach of fully understanding and defining Unmet Needs first – after which the best solutions can be found.

In the work of GNYGCC presenters and participants will be asked to re-frame their observations about the problems, peeves and pitfalls of cardiovascular care for older adults — into Unmet Needs. We hope that you will participate fully in this part of GNYGCC since an important way to most efficiently advance the field of geriatric cardiology is to first start with identifying the most important problems that need to be addressed.

DOMAIN UNMET NEED
Mechanical Circulatory Support Methods to improve risk stratification for bleeding and thrombosis in older adults receiving destination VAD
Advanced Care Planning How to access older adult’s ability to make choices and choose among various health care options
Functional Capacity A method to accurately and continuously monitor functional capacity in older adults so that it can be incorporated as an endpoint in clinical trials
Cardiovascular Syndromes A way to incorporate assessment of geriatric syndromes and frailty in older adults with cardiovascular disorders
Cardiovascular Syndromes An approach to include the assessment of “homestenosis”, frailty or vulnerability to adverse outcomes in older adults with cardiovascular disorders
Cardiovascular Syndromes A definition of resiliency that is operationalizable in the clinical realm
Cardiovascular Syndromes Method to identify basic mechanisms underlying geriatric cardiovascular syndromes that are targets for therapy, given underlying multifactorial complexity
Cardiovascular Syndromes Elucidation of complex mechanistic models that account for multiple pathways –and potential synergisms between pathways– that underlie geriatric cardiovascular syndromes
Drug Therapy Information on Drugs that is representative of older patient populations
Drug Therapy New Medications which are targeted to the physiology and diseases of aging
Drug Therapy Better tools to guide dosing, avoid drug interaction and combine all our knowledge
Frailty How to prevent the development of frailty
Frailty Minimize interactions of Frailty with CVD
Frailty Treating the frail patient at times of stressors to decrease risk
Frailty Methods to identify irreversible frailty and institute palliative interventions
Valve Disease in Older Adults Define the impact of TAVR on symptom relief and maintenance of functionality in older adults
Valve Disease in Older Adults Optimize timing and selection of appropriate therapies including both traditional and percutaneous therapies
Valve Disease in Older Adults Delineate differences between traditional AVR and TAVR on relevant outcomes in older adults
Valve Disease in Older Adults Delineate the mechanisms by which geriatric measures such as frailty confer an increased procedural and long term risk
Chronic Coronary Disease in Older Adults Define appropriate cholesterol goals and treatment strategies in octogenarians
Chronic Coronary Disease in Older Adults Delineate the benefits and risk of primary preventive intervention for CAD in older adults
Chronic Coronary Disease in Older Adults Determine appropriate BP goals for older adults
Chronic Coronary Disease in Older Adults Delineate risk/benefit ratio for percutaneous intervention with drug eluding stents in older adults
Chronic Coronary Disease in Older Adults Delineate benefits of relief of angina on geriatric specific outcomes
Acute MI in Older Adults Define impact of geriatric measures on outcomes by including key data elements to large registries
Acute MI in Older Adults Identify non-cardiac comorbidities that alter/influence cardiac management
Acute MI in Older Adults Develop interventions to reduce adverse outcomes from aforementioned non-cardiac conditions
Acute MI in Older Adults Advanced best practice and systems research focused on drug safety and care model of collaboration
Acute MI in Older Adults Develop a broader perspective on goals of care for older adults with AMI
Prevention and Risk Factors in Older Adults with Heart Disease Novel methods to prevent CVD with BP control, exercise and lipid management
Prevention and Risk Factors in Older Adults with Heart Disease Better risk stratification for older adults with CVD
Prevention and Risk Factors in Older Adults with Heart Disease Effects of medical therapy on broader outcomes (function, mood, cognition, etc.) to be better studied
Prevention and Risk Factors in Older Adults with Heart Disease Clarify therapeutic goals and clinical endpoints pertinent to the elderly
Heart Failure in Older Adults Utility of methods to subgroup patients with HFPEF based on operative pathophysiologic mechanisms.
Heart Failure in Older Adults Identify novel pharmacologic targets to address ventricular vascular coupling abnormalities that underlie heart failure pathophysiology
Heart Failure in Older Adults Define role of non-pharmacologic therapies (e.g. diet) in the genesis of heart failure decompensation and effective methods to intervene.
Heart Failure in Older Adults Methods to improve transitional care of older adults with heart failure.
Heart Rhythm Disorders in Older Adults Elucidate mechanisms and Develop interventions for attenuating age-related effects of aging on the conduction system
Heart Rhythm Disorders in Older Adults Bradyarrhythmias and pacemakers
–Prevention of age-associated bradyarrhythmias
–Pacemaker selection and mode optimization
–Novel therapies (e.g. stem cells, other devices)
Heart Rhythm Disorders in Older Adults Atrial fibrillation
–Primary prevention
–Develop safer and more effective
anti-thrombotic and anti-arrhythmic agents
–Define role of AF ablation and other interventions (e.g. LAA occluders)
Heart Rhythm Disorders in Older Adults Ventricular arrhythmias and ICDs
–Patient selection (i.e. improved risk stratification)
–Refine criteria for generator replacement
–Enhance communication about risks/benefits
Heart Rhythm Disorders in Older Adults Incorporate patient preferences and goals of care into decision-making

Submit an Unmet Need

Join in the process to find solutions to the Unmet Needs of Cardiac Care for the Elderly. Submit your ideas and we will incorporate them into the discussion abelow