Older Adults Research Articles

Introduction: Dementia is increasingly common in older adults, yet limited data exists on its baseline prevalence among those hospitalized with acute coronary syndrome (ACS). This study aims to address that gap by examining the prevalence and subtypes of dementia in older (≥65 years) adults. Methods: These baseline results are part of a retrospective longitudinal cohort study of Kaiser Permanente Northern California members over age 65 years with ACS hospitalization or stable CAD diagnosis from January 2010 to December 2020. Descriptive statistics were used for baseline demographics and clinical variables including prior comorbidities. The prevalence of dementia at baseline, as well as the distribution of type of baseline dementia, was compared in the ACS hospitalization and non-ACS hospitalization groups using Chi-Square test. Results: A total of 189136 patients were included with a mean age 75.2 years. Patients hospitalized for ACS were more likely to be female sex (42.6% versus 41.7%, p=0.022), older (76.7 years versus 74.9 years, p<0.001), and present with higher rates of comorbidities based on the Charlson Comorbidity Index (3.1 versus 2.5, p<0.001) compared to patients without an ACS hospitalization. The overall baseline prevalence of dementia was 5.1%. Patients hospitalized with ACS had a significantly higher baseline prevalence of dementia (5.87% versus 4.97%, p<0.0001). Among patients with dementia, the most common subtype was Alzheimer’s disease (AD, 85.4%), followed by vascular dementia (6.4%), Lewy body/Parkinson’s dementia (LB/P, 4.0%), unspecified types (3.8%), and frontotemporal dementia (0.5%), The distribution of dementia subtypes differed significantly with modestly lower rates of LB/P and Vascular dementia in the ACS hospitalization group (p=0.0215, Table 1). Conclusions: In this large, integrated healthcare cohort, dementia was present in over 1 in 20 older adults in the full cohort, with a significantly higher prevalence among those hospitalized with ACS. AD was the predominant subtype, but small differences in subtype distribution were observed between ACS and non-ACS groups. These findings underscore the importance of recognizing baseline cognitive impairment in the acute cardiovascular care of older adults and may inform future strategies for risk stratification and individualized decision-making.

Background: Socioeconomic status (SES) influences the risk of heart disease (HD) in the general population. Yet, few community-based studies have assessed the impacts of various SES indicators on all-cause mortality among older adults with HD and the interaction effect between SES and HD on all-cause mortality in older communities. Methods: We examined data from a community-based cohort across five provinces in China, comprising 6,110 participants aged ≥60 years (806 with HD). Baseline assessments captured SES indicators (urban/rural residence, education, occupation, personal and family incomes, financial difficulties) and cardiovascular risk factors. HD was documented from doctor-diagnosis questionnaire. Mortality outcomes were ascertained through the cohort follow-up. Results: Over an average follow-up of 4.7 years, the cohort recorded 125 deaths among 806 participants with HD, and 902 deaths among participants without HD. Multivariable-adjusted Cox models showed significant SES-mortality associations in older adults with HD. Rural residents with HD had an elevated mortality risk (fully adjusted hazard ratio [HR] = 3.39, 95% CI: 1.90-6.06) compared to their urban counterparts. All-cause mortality was also significantly increased in older adults with HD who had financial problems over the past two years (HR = 2.71, 1.41-5.20) or an annual personal income <US$300 (HR = 2.21, 1.11-4.40). Fully adjusted analyses showed increased mortality among those with HD who had lower levels of education, occupation, income satisfaction, and family income by 27%-49%, though these did not reach conventional statistical significance. There were significant interaction effects between HD and both rural living and financial hardship on all-cause mortality in older adults. Conclusions: Rural living and financial difficulties emerge as key determinants of mortality disparities among older adults with HD in China. Strategies aimed at enhancing healthcare accessibility in rural communities and implementing targeted economic support to address health inequalities should be essential components of HD interventions.

Introduction: Pulmonary embolism (PE) remains a leading cause of cardiovascular mortality in the US, affecting around 900,000 people annually. Older adults with heart failure (HF) are especially vulnerable due to overlapping risk factors such as venous stasis, endothelial dysfunction, and hypercoagulability. Clinical diagnosis of PE in this population is often challenging, as symptoms often overlap with HF, leading to delayed care. This study examines national trends in PE-related mortality among older adults with HF from 1999 to 2020, considering demographic, gender, and geographic variations. Methods: Death certificate data were extracted from the CDC WONDER database to identify PE-related deaths among individuals aged ≥65 years with coexisting HF. Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percent changes (APCs) with 95% confidence intervals were calculated and standardized to the 2000 U.S. standard population. Rates were stratified by year, age group, sex, race/ethnicity, geographic region, and urbanization level. Results: A total of 49,023 PE-related deaths occurred between 1999 and 2020 among older adults with comorbid HF, with 58.4% in medical facilities, 18.8% in nursing homes, 16.2% at the decedent’s home, and 3.7% in hospice settings. The overall AAMR rose from 4.9 in 1999 to 7.5 in 2020. After an initial rise to 5.3 in 2005 (APC: 1.73; 95% CI: 0.15 to 3.33), the rate declined to 4.7 in 2009 (APC: -2.66; 95% CI: -6.98 to 1.85), followed by significant increases reaching 5.8 in 2018 (APC: 2.09; 95% CI: 1.11 to 3.07) and peaking at 7.5 in 2020 (APC: 13.99; 95% CI: 6.45 to 22.06). Both males and females experienced similar overall trends, though males showed a steeper rise between 2019 and 2020. Non-Hispanic individuals had an overall AAMR nearly twice that of Hispanic individuals (5.5 vs 2.9). Regionally, the Midwest exhibited the highest AAMR (6.0), with Colorado having the highest state-level rate (9.2). Urban-rural stratification revealed greater AAMRs in non-metropolitan areas (Micropolitan: 6.4; NonCore: 6.9) compared to metropolitan regions (Small Metro: 6.1; Medium Metro: 5.4; Large Central: 4.8). Conclusion: PE-related mortality in older adults with HF increased over time, with significant demographic and geographic disparities, highlighting the need for enhanced diagnostic vigilance and targeted prevention and management strategies for this high-risk population.

Background: Non-Ischemic Cardiomyopathy accounts for significant portion of cardiomyopathy with prevalence of about 15% in the community. Non-Ischemic cardiomyopathy (NICM) is a common cause of mortality, especially among older adults. We explored the sex, racial, and geographic trends in the mortality among Older Adults with Non-Ischemic Cardiomyopathy (NICM) in the US from 1999 to 2020 Methods: We performed a retrospective analysis of the national death certificate data from the CDC’s wonder database. We included persons ≥65 years of age with non-ischemic cardiomyopathy (ICD -10 code I42) as the underlying cause of death. The exposure variable was the year of death, and the outcome was NICM age-adjusted mortality rate (AAMR) stratified by sex, race, rural-urban, and census region. We calculated the NICM AAMR per 100,000. Trends were evaluated with Joinpoint regression and expressed as an average annual percentage change (AAPC) with a 95% confidence interval (CI). P<0.05 defined statistical significance. Results: Out of 4.4 billion people, 358,645 deaths occurred from NICM (AAMR 38.9). The AAMR was higher in males (53.4 vs 29.1 in females; P < 0.000001), Blacks (54.9 vs 38.1 in White; P < 0.000001), American Indian (25.1 vs 20.0 in Asian Pacific ; P< 0.000001), Urban (39.6 vs 37.0 in rural P < 0.000001) , Southern region (42.1 vs 40.5 Midwest; P<0.000001) and Northeast (37.1 vs 33.6 in West P<0.000001). The overall AAMR reduced from 54.4 to 25.1 (AAPC -3.0%; CI: -3.2, -2.4). Furthermore, the AAMR decreased significantly in males (AAPC -3.3%; CI: -4.4, -1.7) and females (AAPC -2.8%, CI: -3.3, -1.4). Similarly, it decreased in Blacks (AAPC -5.4%, CI: -8.4, -4.0), White (AAPC -2.9%, CI:-3.2, -2.4), Asian Pacific (AAPC -4.6%, CI:-5.2, -4.0 ), American Indian ( AAPC -4.3%, CI: -5.3,-3.2), rural (AAPC -2.6%, CI: -2.8,-2.3), urban(AAPC -2.6%, CI: -2.7, -2.5) and across all geographic regions. Conclusion: Non-Ischemic Cardiomyopathy mortality has decreased over the last two decades among older adults in the US. Even though Non-ischemic cardiomyopathy mortality has decreased significantly in the last two decades among older adults in the US, there are significant racial disparities, especially between Black and white racial groups. These findings warrant further studies to determine the cause of these disparities and provide solutions to mitigate them.

Evaluating a user-centered design driven multifactorial falls risk assessment tool in primary care: a randomized effectiveness-implementation study.

Introduction: Coronary artery disease (CAD) is the leading cause of death worldwide. Medication management is the priority for its secondary prevention. However, medication adherence was sub-optimal among older adults with CAD, who had greater challenges than younger adults, due to more concerns about the side-effects, forgetfulness and polypharmacy. Comprehensive and rigorously designed educational programmes are needed to improve their medication adherence. Aim: To evaluate the effects of a Health Belief Model based educational programme in improving medication adherence and other related outcomes among older adults with CAD. Methods: This is a two-arm, single-blind, pilot randomised controlled trial, conducted from March to May 2025 in the cardiology department of a tertiary hospital, adopting convenience sampling. The intervention group received a Health Belief Model based educational programme and usual care, and the control group received usual care only. Feasibility (recruitment, completion, attrition rate) and acceptability (semi-structured interviews and satisfaction scales) were assessed. Preliminary effects were measured at immediate post-intervention in terms of the level of medication adherence, perceived benefits and concerns about medications, medication self-management capacity, self-efficacy of medication taking, and health-related quality of life. Between group comparisons were analysed by Mann-Whitney U test, with Hedges’ g effect size calculated by changing scores. Qualitative data were analysed via content analysis. Results: A total of 40 older adults with CAD were recruited, with a 44.9% recruitment and 2.5% attrition rate. In the intervention group, 85% participants attended all sessions. Three categories emerged in the interviews, including perceived benefits and advantages of the intervention, and suggestions for improvement. Significant improvements in the intervention group were observed in medication adherence and perceptions about the benefits of medications (Hedge’s g=0.79 and 1.19), comparing with the control group. The intervention group demonstrated greater improvement in medication self-management capacity and self-efficacy (Hedge’s g=0.62 and 0.46), and greater reduction in the concerns about medications (Hedge’s g=-0.56). Conclusion: The educational programme was feasible and acceptable for older adults with CAD. A large scale randomised controlled trial will be conducted to examine the longer-term effect of the programme.

Introduction: Cardiometabolic conditions, including heart disease (ischemic heart disease or heart failure; HD) and diabetes mellitus (DM), are associated with accelerated functional decline in older adults. The combined presence of both conditions, cardiometabolic multimorbidity (CMM), may pose compounded risk, yet little is known about how this relationship varies by physical activity (PA), sex, and race/ethnicity. Objective: To compare two-year functional decline among older adults with CMM, HD-only, DM-only, and controls, and to assess the moderating effect of PA, sex, and race/ethnicity on the association between CMM and physical function in a nationally representative sample. Methods: We conducted a longitudinal secondary analysis of the 2021-2023 National Health and Aging Trends Study (NHATS, 2021-2023) including 360 community-dwelling older adults. Physical function was assessed using the Short Physical Performance Battery (SPPB). PA was measured via wrist-worn accelerometers and defined as average daily minutes above thresholds for moderate (≥3268 counts/min) and vigorous (≥7890 counts/min) activity. Participants were grouped as HD-only, DM-only, CMM, or neither. Survey-weighted descriptive statistics, linear/logistic regressions, and generalized estimating equation (GEE) tested associations and moderation effects, adjusting for demographic and clinical variables. Analyses were conducted using Stata and R. Results: At baseline, DM and CMM groups had higher BMI and waist circumference, and included fewer females and more non-white participants than controls. While all groups declined in SPPB and PA over time, the DM group experienced a significantly greater decline than controls. Active participants had significantly higher SPPB scores than non-active participants (β = 1.05, 95% CI [0.64, 1.46], p < .001). However, in the HD group, PA benefits were attenuated. In the DM group, females scored lower than males (interaction β = −1.20, 95% CI [−2.27, −0.14], p = .027), and non-white participants had lower scores than controls (β = −0.73, 95% CI [−1.45, −0.01], p = .046). Conclusions: Older adults with DM and CMM had worse function and greater decline, especially among non-active individuals, women, and non-white participants. While PA was generally protective, its effects varied by disease group, supporting the need for tailored interventions in cardiometabolic populations.

Introduction: Sevferal trials have demonstrated that oral anticoagulation reduces ischemic stroke risk in patients with atrial fibrillation (AF), the most common cardiac arrythmia among older adults. The impact of initiation of an anticoagulant on ischemic stroke risk in real-world clinical practice is not known. Research Objective/Aim: To determine the association between initiation of anticoagulation and the hazard of ischemic stroke and major bleeding events among older adults with incident AF. Methods: This was a retrospective cohort study based on inpatient, outpatient, emergency department, and skilled nursing facility claims files for a 5% sample of United States fee-for-service Medicare beneficiaries aged 66 years and older who developed incident AF between 2007 and 2020. Using a sequential trial framework, the rates of ischemic stroke and major bleeding events were computed in those who did and did not initiate an anticoagulant, using both crude estimates and those derived in propensity score-overlap weighted cohorts. The primary effectiveness endpoint was ischemic stroke. The primary safety end point was major bleeding. To reduce the impact of selection bias and immortal time bias, unadjusted and adjusted hazard ratios (HRs) and rate differences were computed in a dataset comprised of pooled, sequential clinical trial replicates starting one month apart. Results: In total, 144,969 patients (60.8% female; mean age 77.7 years [standard deviation (SD) 7.1]) were included in the study. Figure 1 shows the flowchart of patient selection. Figure 2 shows the characteristics of the cohort. Figure 3 summarizes study end points. The mean follow-up period was 3.46 years (SD 2.98 years). Initiation of anticoagulation was not associated with a reduced hazard of ischemic stroke (adjusted hazard ratio [aHR] 1.01 [95% CI: 0.97 – 1.05]). However, initiation of anticoagulation was associated with an increased hazard of a major bleeding event (aHR 1.38 [95% CI: 1.36 – 1.40]) and increased hazards of intracerebral hemorrhage (ICH), and major gastrointestinal hemorrhage. There was a reduced hazard of all-cause mortality (aHR 0.86 [95% CI: 0.85 – 0.88]) and no difference in the hazard of 4 falsification end points. Conclusion: Among older adults, first anticoagulant prescription was not associated with a reduced hazard of ischemic stroke. However, crude analyses suggested that clinicians are appropriately selecting patients for anticoagulation in routine clinical practice.

Background: Cardiovascular disease management in older adults is complicated by geriatric syndromes. Comprehensive Geriatric Assessment (CGA)—a multidisciplinary evaluation of functional, cognitive, nutritional, and social domains—may improve outcomes, but its effects on cardiovascular-specific endpoints remain unquantified. Research Question: Does CGA reduce cardiovascular mortality and hospitalizations in adults ≥65 years with cardiovascular disease compared to usual care? Methods: We conducted a PRISMA-compliant systematic review and meta-analysis of 15 studies (9 randomized controlled trials, 4 cohorts, 2 quasi-experimental; n=3,632) from PubMed, EMBASE, Cochrane, Web of Science, and CINAHL (2005–2025). Included studies implemented multidisciplinary CGA (≥3 domains) in older adults with cardiovascular conditions. Primary outcomes were cardiovascular mortality, heart failure hospitalization, acute coronary syndrome events, stroke, and 30-day readmissions. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models. Results: CGA significantly reduced cardiovascular mortality by 18% (9 studies; RR 0.82, 95% CI 0.75–0.90; p<0.001), heart failure hospitalizations by 24% (7 studies; RR 0.76, 0.68–0.85; p<0.001), and 30-day readmissions by 15% (6 studies; RR 0.85, 0.77–0.94; p=0.002). Greatest benefits occurred in frail patients (heart failure hospitalization RR 0.72, 0.65–0.80; p<0.01) and with ≥4 CGA domains (mortality RR 0.78, 0.71–0.86). No significant effects were observed for acute coronary syndrome (RR 0.92, 0.80–1.05) or stroke (RR 0.97, 0.83–1.18). Conclusions: CGA reduces cardiovascular mortality and heart failure hospitalizations in older adults, particularly frail individuals. Integration into cardiology-geriatrics collaborative models is recommended. Disease-specific adaptations may be needed for acute coronary syndrome and stroke.

Background: The combined impact of atrial fibrillation (AF) and structural cardiac abnormalities on heart failure (HF) risk remains incompletely understood in older adults. We examined whether echocardiographic parameters and cardiac biomarkers modify the association between AF and risk of incident HF. Methods: Among 5,572 participants aged ≥65 years without baseline HF from the ARIC study, we investigated the association between prevalent AF and incident HF over median follow up of 9 years. We tested interactions between AF and cardiac biomarkers (hs-cTnT, hs-cTnI, and NT-proBNP as continuous variables) and echocardiographic parameters including left atrial volume index (LAVI), average E/e', left ventricular ejection fraction (LVEF), longitudinal strain, left ventricular mass index (LVMI), and mitral regurgitation jet area as continuous variables using Cox regression. Significant interactions were further studied using stratified analyses with clinically relevant cutpoints. Results: Among participants (mean age 76, standard deviation: 5 years, 60% female, 21% Black), 359 (6.4%) had prevalent AF. Baseline AF was significantly associated with HF risk (hazard ratio [HR]: 2.52, 95% confidence interval [CI]: 1.95-3.25). No significant interactions were found with cardiac biomarker analyses. Significant interactions were observed between AF and LAVI (p=0.006), E/e' (p=0.043), and mitral regurgitation jet area (p=0.015), with attenuation of the effect of AF on incident HF risk in the presence of abnormal echocardiographic parameters. Participants with concomitant AF and abnormal echocardiographic findings had the highest absolute risk of incident HF: those with AF and LAVI ≥35 ml/m 2 had an event rate of 50.1 per 1000 person-years (HR: 3.80, 95% CI: 2.71-5.34 vs. no AF + LAVI <35 ml/m 2 ), while those with AF and E/e' >14 had an event rate of 49.6 per 1000 person-years (HR: 3.68, 95% CI: 2.37-5.71 vs. no AF + E/e' < 14). Conclusion: In older adults, the association between AF and HF varies by cardiac structural parameters, with attenuated effects in those with pre-existing structural abnormalities. Despite effect attenuation, absolute risk remains highest in those with both abnormal echocardiographic findings and prevalent AF, identifying a high-risk phenotype that can inform approaches to risk stratification in older adults and may warrant intensified prevention strategies.

Background: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in middle-aged and older adults. Both the estimated glucose disposal rate (eGDR), and hs-CRP have been identified as important risk factors for CVD. However, their combined influence on CVD risk in this population remains inadequately explored. Aim: This study aims to investigate the association between eGDR, hs-CRP, and the risk of CVD in middle-aged and older adults. Methods: Data were from the China Health and Retirement Longitudinal Study (CHARLS), which included 17,708 participants at baseline in 2011. After excluding those with cardiovascular disease (CVD) and missing follow-up data, 6,823 participants were enrolled. eGDR was calculated using the following formula: eGDR=24.31−(0.22×Waist Circumference)−(0.33×Systolic Blood Pressure)+(0.43×Fasting Plasma Glucose)eGDR=24.31−(0.22×Waist Circumference)−(0.33×Systolic Blood Pressure)+(0.43×Fasting Plasma Glucose). eGDR was categorized according to quartiles. The primary outcome was the incidence of heart diseases and stroke. Results: Among the 6,823 participants enrolled, the mean age was 59.14 ± 8.75 years, and 3,080 (45.1%) were male. During a maximum follow-up period of 9 years, 1,950 (28.6%) developed CVD. After adjusting for confounding factors, the risk of CVD incidence was highest in the lowest quartile (Q1) of eGDR compared to the highest quartile (Q4) (HR: 1.62, 95% CI: 1.38-1.88), followed by Q2 (HR: 1.34, 95% CI: 1.16-1.54). Elevated hs-CRP levels (≥2 mg/L) were associated with a 1.15-fold increased risk of CVD (95% CI: 1.04-1.27) compared to lower hs-CRP levels (<2 mg/L). When considering both eGDR and hs-CRP levels, the combined effect revealed the highest risk in individuals with the lowest eGDR (Q1) and elevated hs-CRP (HR: 1.75, 95% CI: 1.44-2.12), followed by those with Q1 of eGDR and low hs-CRP (HR: 1.59, 95% CI: 1.34-1.89), Q2 of eGDR with high hs-CRP (HR: 1.50, 95% CI: 1.22-1.84), and Q2 of eGDR with low hs-CRP (HR: 1.31, 95% CI: 1.12-1.54) (Table 1) Conclusion: In this large real-world study, we found that individuals with high eGDR and elevated hs-CRP had the highest risk of CVD. These findings highlight the combined role of insulin sensitivity and inflammation in predicting CVD risk and provide valuable insights into cardiovascular risk, aiding in early detection and targeted prevention strategies for CVD.

Background: The American Heart Association recently released the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equation for estimating cardiovascular disease (CVD) risk in primary prevention adults aged 30-79. However, its performance in older adults aged 80 years and older is uncertain. Also, the utility of coronary artery calcium (CAC) for CVD prediction improvement beyond PREVENT is unknown. Methods: We studied 1,912 ARIC older adult participants (mean age 80 [SD 4] years) with CAC data but without a history of coronary heart disease (CHD), stroke, and heart failure (HF) at Visit 7 (2018-2019). We first assessed c-statistics and calibration indices of the PREVENT in our older adult population. Then, we compared the predictability between PREVENT and CAC, with total CVD (atherosclerotic CVD [ASCVD, including CHD and stroke] and HF), and all-cause mortality as outcomes of interest, using Cox regression models. Results: Over a median follow-up of 3.7 (IQI 2.6-4.3) years, there were 144 CVD events (81 ASCVD and 75 HF) and 210 deaths. PREVENT demonstrated good calibration (calibration slope 0.74 for total CVD) and discrimination (c-statistic 0.621), and the results were similar in participants aged 80+ vs. those aged 75-79 years. CAC significantly improved prediction of total CVD (0.078 [95% CI 0.034, 0.122]), ASCVD (0.083 [0.026, 0.140]), and HF (0.069 [0.016, 0.123]) beyond PREVENT, but this was not the case for all-cause mortality (left panel of Figure). In contrast, PREVENT improved only the prediction of all-cause mortality beyond CAC (right panel of Figure). The results were largely similar between the age of 80+ vs. 75-79. Conclusions: PREVENT overall performed well even in older adults aged 80+ years. CAC further improved CVD risk prediction beyond and above PREVENT in the-75-and-older adults. Our findings suggest broad usefulness of PREVENT and further support the value of CAC for assessment of primary CVD risk in very older adults.

Introduction: Routine physical activity reduces the risk of death and cardiometabolic diseases and increases cardiovascular fitness measured as peak oxygen uptake (VO 2 peak). However, the change in VO 2 peak with exercise training has significant variability, and many healthy individuals do not show improvement in VO 2 peak with recommended doses of exercise. In young, healthy individuals exercise nonresponse has been overcome with increased frequency and intensity (dose) of exercise but the effect of age on this phenomenon is unknown. Research Question: Do changes in VO 2 peak in response to aerobic exercise training have a dose-response relationship in healthy, older adults? Methods: 61 sedentary, healthy older adults were recruited and randomized to one year of Yoga/Tai-Chi, or graded aerobic exercise with training load measured by training impulse (TRIMP), a measure accounting for time and intensity based on heart rate. Peak VO 2 was measured at baseline and one year via a modified Astrand-Saltin treadmill protocol with Douglas bag technique. Results: The mean age was 67 +/- 6.2 years. There were no significant differences in baseline characteristics between groups. One year of aerobic training significantly increased VO 2 peak when compared to one year of strength/balance training in older patients (+2.25 mL/kg/min [1.33, 3.17]). The VO 2 peak response had a moderate correlation with training load (R 2 of 0.51, p Trend <0.001) (Figure 1A) . Grouping by TRIMP/month at steady state months 6-12, (<600, 600-900, >900/month), medium and high TRIMP doses had significantly more gains in VO 2 peak compared to the low TRIMP and static control groups (p<0.001) (Figure 1B) . A dose of 744 TRIMPs/month (roughly 90 minutes of vigorous activity per week) was required to improve VO 2 peak by 1.75mL/kg/min (0.5 MET). Using multivariate logistic regression, exercise nonresponse, defined as change in VO 2 peak <1.75 mL/kg/min, was found not to be associated with age, sex, lean body mass, body fat percentage, BMI, or baseline VO 2 peak. Conclusion: The VO 2 peak of healthy, older adults has a dose-response relationship with aerobic training load, suggesting exercise nonresponse may be overcome and addressing a lack of knowledge for this growing population. Improvements in VO 2 peak were seen at moderate TRIMP doses of 600 TRIMPs/month, and increased proportionally with higher achieved training impulses.

Background: Patients who are older and those that are frail are routinely referred for LAAC but may be at increased risk of adverse events following device implant. It is unclear how age and frailty interact and if measures of frailty can support risk stratification in older adults. Research Question: Will measures of frailty improve risk stratification for LAAC in older adults? Methods: The WATCHMAN FLX Pro Device SURveillance Post Approval AnalySiS Plan (SURPASS Pro) is a multicenter, prospective, observational analysis that acquires data from the NCDR LAAO Registry. Patients discharged Oct 2023 – Jun 2024 with an attempted WATCHMAN FLX Pro implant were stratified by age (≥80 and <80 years) and then by frailty (non-frail, pre-frail, and frail) based on measures of hemoglobin, creatinine, albumin, BMI, and increased fall risk. Key safety events (death, ischemic stroke, systemic embolism, device/procedure-related events through discharge or 7 days, whichever is later) and clinical events through 45 days were assessed. Results: Of 21,595 patients in SURPASS Pro, 8,203 (38.0%) were ≥80 years and 13,392 (62.0%) were <80 years old. The older group had a higher mean CHA 2 DS 2 -VASc score (5.0 ± 1.4 vs 4.3 ± 1.4) and slightly fewer females (39.4% v 43.7%). Implant success was high for both groups (96.3% [≥80] and 97.3% [<80]). Composite occurrence of key safety events was similar (0.27% [≥80] and 0.16% [<80]; p=0.10), but mortality was higher in those ≥80 (0.18% v 0.05%; p<0.01). The older group had 1,394 (17%) non-frail, 6,629 (80%) pre-frail, and 180 (2.2%) frail individuals. Frailty showed a significant association for the key safety endpoint (p<0.01) driven by mortality (Table 1) and frailty was associated with increased 45-day mortality (p<0.01) (Figure 1A). The younger group had 4,104 (31%) non-frail, 9,156 (68%) pre-frail, and 132 (1%) frail individuals. In this group, frailty showed a significant association for the key safety endpoint (p<0.01) driven by ischemic stroke and device or procedure-related events (Table 1). Frailty was also associated with higher rates of 45-day mortality and bleeding in the younger group (Figure 1B). Conclusion: Only 1 in 5 patients ≥80 years undergoing LAAO is non-frail. Age ≥80 years and frailty are associated with higher relative rates of safety events and mortality, though the absolute risks are very low. Frailty and age ≥80 years can help refine clinical risk stratification for LAAC but should not be considered prohibitory.

Introduction: Older adults with heart failure (HF) have well-established barriers to consistent engagement in effective self-care behaviors. Inadequate self-care leads to declines in functional status, diminished quality of life, and increased rates of hospitalization. We evaluated a sensor-controlled digital game (SCDG), Heart Health Mountain, that used data from sensor devices (smart scale and activity tracker) to promote engagement in HF self-care compared to a control group that received only the sensor devices. Hypothesis: A SCDG would improve HF-related outcomes of self-efficacy, knowledge, self-care behaviors, functional status, quality of life, and hospitalizations compared to a sensor control group at weeks 6, 12, and 24. Methods: In this decentralized, 6-month RCT, 200 adults aged >45 years with NYHA Class I-III HF from 20 southern U.S. states were randomized 1:1 to either the intervention group (IG) or control group (CG). Outcome variables were collected at baseline and the 3 timepoints using online surveys. Analyses included descriptive statistics and linear mixed-effects models to assess group, time, and interaction effects. Results: Of 146 participants who completed the 6-month RCT from the 199 enrolled at the time of this abstract (mean age 59.4 years; 65.8% male; 80.8% White, 52.1% with financial hardship), 72 were randomized to the IG and 74 to CG. Linear mixed-effects models showed significant improvements over time in self-care confidence (SCHFI: +14.7 points at 24 weeks, p < .001), self-care behaviors (EHFBS: +8.1, p < .001), functional status (KCCQ: +5.6, p = .003), and quality of life (KCCQ-QoL: +12.9, p < .001), but no significant group-by-time effects. HF knowledge remained stable over time, with no statistically significant change observed (AHFKT: +1.31 at 24 weeks, p = 0.466). HF-related hospitalizations were lower in the IG at 6 weeks (4.2% vs. 18.9%), with smaller differences at later time points (e.g., 24 weeks: 16.7% vs. 17.6%). Conclusion: Although the SCDG (IG) did not result in statistically significant differences in outcomes compared to CG, both groups who received sensor-based digital tools showed significant improvements over time in self-efficacy, self-care behaviors, functional status, and quality of life among older adults with HF. These findings highlight the potential of digital tools to improve HF self-management and underscore the need for future interventions that are more personalized and adapted to individual needs.

Background: Cardiac arrest (CA) remains a major contributor to cardiovascular-related mortality in the United States. The coexistence of cancer significantly exacerbates overall disease burden. This study investigates CA and cancer-related trends and demographic disparities in adults from 1999 to 2023. Methods: A retrospective analysis of CDC WONDER data was conducted to investigate the trends in mortality associated with CA (ICD codes: I46.x) in patients with cancer (ICD codes: C00-C97). Using Joinpoint regression analysis, the study calculated age-adjusted mortality rates (AAMR) per 100,000 individuals and corresponding annual percentage changes (APC), along with 95% confidence intervals. The year, sex, race/ethnicity, age groups, and state were used to stratify the data. Results: Between 1999 and 2023, CA in cancer was responsible for 1,503,315 deaths. With an AAPC of -2.3 (95% CI: -2.4 to 2.1, p < 0.001), the overall AAMR decreased from 37.3 in 1999 to 21.1 in 2023. Adult men had higher AAMRs than women (men: 48.4; women: 30.4) in 1999 to (men: 25.7; women: 17.8) in 2023, with decline for both sexes [men: AAPC: -2.5, p < 0.001; women: AAPC: -2.4, p < 0.001]. AAMRs varied significantly by race, for NH Black individuals (57.6 to 28.1), NH American Indians (22.1 to 15.5), Hispanics (44.6 to 24.7) and NH Whites (34.4 to 19.5) from 1999 to 2023 respectively. The AAMR decreased for all races from 1999 to 2023, most notably in Black individuals (AAPC: -2.9, p < 0.001). The AAMR decreased for all age groups (2.6 to 1.6) in younger adults (25-44 years), (23.7 to 13.5) in middle-aged adults (45-64 years), and (143.4 to 80.6) in older adults (65+ years) from 1999-2023, but the greatest decline was observed in older adults (AAPC: -2.2, p < 0.001). The AAMR decreased for all census regions, for Northeast (62.3 to 30.9), similarly for Midwest (17.2 to 11.7), South (31.0 to 13.5), and for West it was (46.5 to 34.8) from 1999 to 2023 respectively, but the highest decline was seen in South region (AAPC: -3.3, p < 0.001). AAMRs varied by state, from 5.2 in West Virginia to 55.3 in California during 2023. Conclusion: This study reveals significant demographic and geographic disparities in CA and cancer-related mortality among U.S. adults from 1999-2023, with a disproportionately high burden observed in older adults, males, and NH Black individuals. These findings underscore the urgent need for targeted, equity-driven public health strategies for high-risk groups.

Background: GLP-1 receptor agonists (GLP-1 RAs) are known to reduce cardiovascular risk in type 2 diabetes. However, their effectiveness in primary prevention, particularly among older adults who were underrepresented in landmark trials, remains uncertain. Research Question: Does early GLP-1 RA initiation reduce the risk of major adverse cardiac and renal events (MACRE) in older adults with type 2 diabetes and no baseline cardiovascular or renal disease? Method: Using a target trial emulation framework, we conducted a retrospective cohort study within the TriNetX Global Research Network. We included patients aged ≥75 years with type 2 diabetes with baseline metformin between December 5, 2017, and December 5, 2024. Patients with prior heart failure (HF), myocardial infarction (MI), coronary revascularization, acute kidney injury (AKI), chronic kidney disease (CKD), or dialysis dependence were excluded to ensure a primary prevention cohort. We also excluded those on other glucose-lowering agents prior to metformin or with contraindications or barriers to GLP-1 RA access. Patients were assigned to either (1) GLP-1 RA initiation or (2) initiation of other non-GLP-1 RA medications within 6 months of their first metformin. Propensity score matching (1:1) was used to balance covariates. The primary outcome was MACRE: all-cause mortality, incident HF, MI, AKI, CKD, or dialysis dependence. Secondary outcomes included the individual MACRE components and HF hospitalization. Safety outcomes included gastroparesis, nutritional deficiency, sarcopenia, or falls. Follow-up extended up to 3 year or until an outcome event, death, or loss to follow-up. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, with P< 0.05 considered significance. Results: A total of 1,835 GLP-1 RA users were matched to 1,835 non-users, with balanced covariates (mean age: 78.7 vs. 78.6 years; male: 45.2% vs. 46.7%; BMI: 32.2 vs. 31.7 kg/m 2 ; HbA1c: 7.6% vs. 7.9%). Early GLP-1 RA initiation was associated with a 33% lower risk of MACRE compared to non-use (HR: 0.67; 95% CI: 0.58–0.78) (Table) . Subgroup analyses showed consistent reductions in MACRE across comparisons with other glucose-lowering therapies (Figure) . All secondary outcomes were also significantly lower among GLP-1 RA users (Table) . Conclusion: In a primary prevention cohort of older adults with type 2 diabetes, early initiation of GLP-1 RA was associated with significantly lower risk of MACRE.

Background: Frailty is a common condition in older adults, associated with an increased risk of cardiovascular disease (CVD). The triglyceride-glucose index (TyG), a marker of insulin resistance, has also emerged as a potential predictor of CVD risk. Frailty and insulin resistance often coexist in the elderly, however, the combined role of frailty and TyG in the incidence of CVD remain unclear. Purpose: This study investigates the combined association of frailty and TyG with the incidence of CVD in middle-aged and older adults. Methods: This study utilized data from five waves of the China Health and Retirement Longitudinal Study (CHARLS). Frailty status was assessed using the Rockwood frailty index, which classified participants into three categories: robust (FI ≤ 0.10), pre-frail (0.10 < FI < 0.25), and frail (FI ≥ 0.25). The TyG index was calculated as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL) / 2] and categorized based on the median value. The cox regression and mediation analysis were used to assess the association between frailty status, TyG, and the incidence of CVD. Results: A total of 5,997 participants aged 45 years and older (48.40% male; mean age 57.51 ± 8.40 years) with no cardiovascular disease were enrolled in 2011. Over a maximum follow-up period of 9 years, 1,640 (27.3%) individuals developed CVD. After adjusting for potential confounders, the combined impact of frailty status and TyG showed the highest risk in frail individuals with high TyG (HR 2.30, 95% CI: 1.86-2.86), followed by frail individuals with low TyG (HR 1.92, 95% CI: 1.52-2.43), pre-frail individuals with high TyG (HR 1.85, 95% CI: 1.58-2.15), pre-frail individuals with low TyG (HR 1.76, 95% CI: 1.50-2.06), and robust individuals with high TyG (HR 1.17, 95% CI: 1.02-1.36) (Figure 1). Additionally, frailty status was found to significantly mediate 17.21% of the association between TyG and CVD (Figure 2). Conclusions: The results highlight the combined effect and mutual mediation between frailty status and TyG on the incidence of CVD. It is important to consider both frailty status and TyG together in risk assessments for better residual risk stratification and primary prevention of cardiovascular diseases, particularly in older populations.

Background: Evidence on the safety of atrial fibrillation (AF) catheter ablation in U.S. patients over 80 years old remains limited. With growing life expectancy, more elderly individuals are being considered for this intervention, underscoring the need for age-specific safety data to guide clinical decision-making. Hypothesis: Elderly age is associated with increased procedural complications and mortality, suggesting a higher-risk profile and reduced safety. Aim: To provide critical insights into the real-world risks and complications. Methods: In this U.S.-based multicenter cohort study using the TriNetX dataset, we identified adults (≥ 60 years old) with new-onset AF and underwent catheter ablation within 6 months. Patients were categorized by age into first AF between 60 to 79 years old (defined as older adults), and first AF older than 80 years old (defined as elderly adults). Propensity score matching (1:1) balanced groups by demographics, comorbidities, and medications. The primary end point was the risk of repeat AF ablation at 3-year intervals. Secondary endpoints included new or ongoing antiarrhythmic (AAD) use, ischemic stroke, safety outcomes including heart failure (HF) exacerbations, composite pericardial complications, new venous thromboembolism (VTE), cardiac arrest, vascular access complications and all-cause hospitalizations, and all-cause death. Falsification outcomes included urinary tract infections (UTI) and herpes zoster. Kaplan-Meier analysis and log-rank tests compared outcomes; hazard ratios (HRs) with 95% CI were calculated using Cox regression. Results: After propensity score matching into well-balanced groups (N= 5,032 per group at 3-year follow-up), elderly adults were more likely to receive repeat catheter ablation. There were no differences between groups in AAD, VTE outcomes. Elderly adults were at higher risk of ischemic stroke (HR = 1.75, 95% CI = 1.52-2.02, p=0.002), new HF exacerbation (HR=1.75, 95% CI = 1.52-2.02, p<0.01), and new complete heart block or sick sinus syndrome (HR=1.85, 95% CI =1.59-2.16, p<0.01). Elderly adults were also more likely to encounter all-cause hospitalizations (HR=1.39-1.48, p<0.01) and all-cause death (HR=1.98, 95%CI=1.71-2.30, p<0.01). Conclusion: Elderly adults (≥80 years) undergoing AF ablation had significantly higher risk of complications than older adults (60-79 years). This underscore the importance of further investigations to ascertain the risk factors and potential development of screening tool.

Background: Cognitive impairment is a frequent and debilitating comorbidity in older adults with heart failure (HF). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve HF-related outcomes, but their effect on cognitive outcomes is not well established. Research Question: Does treatment with the SGLT2i empagliflozin or dapagliflozin reduce the incidence of cognitive impairment in older adults with HF? Methods: We conducted a retrospective, propensity score-matched cohort study using TriNetX, a global electronic health records database. Adults ≥60 years of age with a diagnosis of HF between July 1, 2020, and March 31, 2023, were included ( Figure 1 ). Patients with pre-existing dementia, type 1 diabetes or chronic kidney disease were excluded. A total of 50,188 SGLT2i users (empagliflozin n=32,761 [65.3%]; dapagliflozin n=17,427 [34.7%]) were propensity score–matched 1:1 to non-user controls based on demographic and clinical variables. Outcomes were assessed over a 2-year follow-up, and included incident diagnosis of Alzheimer’s disease (AD), vascular dementia (VD), mild cognitive impairment (MCI), unspecified dementia, and drugs related to AD. Cox proportional hazards models were used to estimate hazard ratios (HRs). Results: The matched cohorts had a mean age of 72.0 years (empagliflozin) and 71.5 years (dapagliflozin); approximately 58–59% were male and 43–49% had diabetes mellitus. Baseline characteristics were adequately matched ( Table 1 ). Empagliflozin use was associated with significantly reduced risk of AD (HR 0.61, 95% CI 0.48–0.77, p<0.001), VD (HR 0.56, 95% CI 0.44–0.71, p<0.001), unspecified dementia (HR 0.59, 95% CI 0.52–0.67, p<0.001), and initiation of drugs related to AD (HR 0.73, 95% CI 0.62–0.85, p<0.001) ( Table 2 ) Dapagliflozin showed similar protective associations with VD (HR 0.48, 95% CI 0.33–0.68, p<0.001), unspecified dementia (HR 0.65, 95% CI 0.54–0.77, p<0.001), initiation of drugs related to AD (HR 0.76, 95% CI 0.61–0.96, p=0.021), and MCI (HR 0.76, 95% CI 0.60–0.97, p=0.028). Conclusion: In a real-world study of older adults with heart failure, empagliflozin and dapagliflozin use was associated with a lower risk of incident cognitive impairment. While mechanisms such as improved cerebral perfusion, attenuation of neuroinflammation or modulation of metabolic and vascular pathways implicated in neurodegeneration are plausible, prospective studies are needed to confirm these associations and elucidate causal pathways.