Imagine a healthcare landscape where seniors navigating heart health challenges aren't sidelined by outdated systems—yet, shockingly, that's the reality for millions. But here's where it gets controversial: Could embracing tech and rethinking trials actually revolutionize care, or are we overlooking risks that could do more harm than good? Let's dive into the insights from the American Heart Association (AHA) 2025 Scientific Sessions, where experts discussed how digital innovations, broader clinical studies, and smarter medication strategies could transform cardiovascular treatment for our aging population.
There's an urgent need for cardiology approaches and research studies to truly mirror the complexities of getting older. During the AHA 2025 Scientific Sessions (available at https://www.ajmc.com/conference/aha), presenters stressed that elderly individuals are still severely underrepresented in heart-related research (check out https://www.ajmc.com/compendium/cardiovascular), encounter distinct obstacles in managing high blood pressure, and face heightened chances of overmedication and unnecessary treatments.
Overcoming Hurdles in Digital Solutions for Blood Pressure Control
John A. Dodson, MD, MPH, an associate professor of medicine at New York University, kicked off the discussion by exploring how digital health tools (detailed at https://www.ajmc.com/compendium/digital-health) might bridge longstanding shortcomings in controlling blood pressure. Even as smartphones become ubiquitous for health monitoring, Dodson pointed out that effective hypertension management remains disappointingly low among seniors (as explored in https://www.ajmc.com/compendium/population), often due to a mix of co-existing health issues, reduced mobility, and struggles with sticking to medication regimens.
The effectiveness of these digital health aids hinges on tackling the everyday challenges seniors encounter, Dodson emphasized. Many face what he termed a 'utility cost,' that nagging sense that mastering new tech isn't worth the hassle. 'Technology can feel exasperating,' he remarked, noting that worries about data privacy and reluctance to adapt are perfectly normal reactions.
And this is the part most people miss: Physical constraints, like vision problems (covered in https://www.ajmc.com/compendium/ophthalmology), hearing difficulties, joint pain, or shaky hands, can turn device handling into a real struggle, while mental declines impacting memory or logic make it even tougher. 'When designing programs to shift health habits, it's far more intricate than just telling someone to grab their phone,' Dodson explained, drawing from two NIH-supported studies from his team to illustrate how to better involve elderly participants.
Take the phase 2 RESILIENT trial (found at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2828802 and NCT03978130 on https://clinicaltrials.gov/study/NCT03978130), which examined if phone-based heart rehab could boost physical abilities in people 65 and up with blocked heart arteries. This randomized study, involving 400 volunteers at five universities, revealed that mobile rehab didn't markedly improve their 6-minute walking distance over standard care—just a 15.6-meter gain, short of the 25-meter mark for meaningful change. Yet, engagement played a huge role; those who fully dove into weekly online tasks saw real functional gains, hinting that enthusiasm, extra support, and smarter prediction methods could unlock success.
'If we could identify likely winners upfront or encourage them mid-intervention, these digital methods could really shine,' Dodson noted. On the flip side, the BETTER-BP study (NCT04114669 at https://clinicaltrials.gov/study/NCT04114669), a practical trial blending behavioral nudges with text reminders for BP adherence, included 20% of participants aged 65+, retaining 87% after six months. Dodson attributed this to tailoring approaches—like offering multilingual staff, covering travel costs (as in https://www.ajmc.com/compendium/reimbursement), and instant tech help—instead of abandoning folks to figure it out alone. Full results are slated for release on Sunday, November 9.
Broadening Inclusion in Heart Disease Research
Michael Nanna, MD, MHS, an assistant professor of internal medicine and interventional cardiologist at Yale School of Medicine, addressed the ongoing scarcity of elderly representation in coronary artery disease studies. Though outright age bans have dwindled, seniors are often quietly sidelined by factors like other illnesses, frailty, travel hassles, medication overload, or disinterested doctors (touching on https://www.ajmc.com/topic/healthcare-delivery).
'For results that apply broadly, you need participants spanning the full range of aging biology,' Nanna asserted.
This principle drove the LIVEBETTER study (NCT05786417 on https://clinicaltrials.gov/study/NCT05786417), a PCORI-funded project pitting beta-blockers against calcium blockers for easing chest pain in 640 people 65 and older. What makes it stand out, he said, is its foundation: The main goal—overall life quality—was chosen with input from patients and caregivers, capturing an element often ignored in studies: holistic well-being.
'Getting caregivers involved is vital for enrolling seniors in trials, which is why LIVEBETTER includes them as participants alongside patients and tracks their stress over time,' Nanna elaborated. The research also uses virtual check-ins and local collaborations to ease barriers. 'Practical studies for the elderly aren't merely doable—they're crucial,' he declared. 'Blending input from all parties, honoring doctor-patient relationships, covering the aging spectrum, and adapting to seniors' needs are absolute musts for real progress.'
Navigating Deprescribing and Medication Overload in Comprehensive Care
Mark Effron, MD, a professor of medicine and cardiologist at Ochsner Health (partnered at https://www.ajmc.com/partners/ochsner), turned the spotlight to reducing medications and the weight of polypharmacy. Through a real-life example, he demonstrated how one patient qualifying for standard treatments across four conditions could end up with prescriptions from up to 11 drug categories solely for heart issues.
While drugs are essential for tackling cardiovascular problems, their buildup can introduce fresh dangers, particularly for seniors who might skip doses, suffer from drug clashes, risk falls, become disabled, face hospital stays, or even experience worsened heart outcomes. This sparks what Effron dubbed 'inherent tension' between necessary treatments and overmedication, forcing doctors to evaluate if each pill's perks outweigh its downsides, especially when they clash with personal priorities.
He also cautioned about 'therapeutic competition,' where curing one ailment aggravates another. Picture beta-agonists for lung issues speeding up irregular heartbeats, or painkillers for joint woes increasing bleeding chances. For seniors juggling multiple health battles, these ripple effects demand vigilant oversight and a tailored equilibrium between aiding and avoiding damage.
'We're not serving our patients well,' Effron shared with The American Journal of Managed Care®. 'But let's not swing too far in undertreating and invite issues they never had.'
Two deprescribing experiments—a Veterans Affairs trial in nursing homes (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2827023) and the OPTIMISE trial for those 80+ (NCT06935760 at https://clinicaltrials.gov/study/NCT06935760)—showed no rise in deaths or heart events after cutting BP meds. Effron highlighted the potential of n-of-1 trials too, which personalize medication tapering for individual responses. 'It delivers custom drug therapy and pinpoint accuracy amid diverse health profiles, drug processing, treatment reactions, and personal values,' he explained.
But here's where it gets controversial: Is cutting back on meds a bold step toward safer care, or could it accidentally lead to undertreatment that exacerbates conditions? This debate rages on, as balancing risks versus benefits isn't always black and white.
References
- Dodson JA. Modernizing hypertension management in older adults: pragmatic trials with digital health. Presented at: AHA 2025 Scientific Sessions; November 7-10, 2025; New Orleans, LA.
- Dodson JA, Adhikari S, Schoenthaler A, et al. Rehabilitation at home using mobile health for older adults hospitalized for ischemic heart disease: the RESILIENT randomized clinical trial.JAMA Netw Open. 2025;8(1):e2453499. doi:10.1001/jamanetworkopen.2024.53499
- Nanna M. Opportunities and challenges for the enrollment of older adults in pragmatic trials to address coronary artery disease. Presented at: AHA 2025 Scientific Sessions; November 7-10, 2025; New Orleans, LA.
- LIVEBETTER: a trial comparing medications in older adults with stable angina and multiple chronic conditions (LIVEBETTER). ClinicalTrials.gov. Updated February 6, 2025. Accessed November 7, 2025. https://clinicaltrials.gov/study/NCT05786417
- Effron MB. Deprescribing and decision-making: pragmatic trials in cardiovascular care for older adults. Presented at: AHA 2025 Scientific Sessions; November 7-10, 2025; New Orleans, LA.
- Odden MC, Graham LA, Liu X, et al. Antihypertensive deprescribing and cardiovascular events among long-term care residents.JAMA Netw Open. 2024;7(11):e2446851. doi:10.1001/jamanetworkopen.2024.46851
- Sheppard JP, Burt J, Lown M, et al. Effect of antihypertensive medication reduction vs usual care on short-term blood pressure control in patients with hypertension aged 80 years and older: the OPTIMISE randomized clinical trial. JAMA. 2020;323(20):2039-2051. doi:10.1001/jama.2020.4871
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What are your thoughts on integrating digital tools into senior heart care—do you see it as a game-changer or a potential privacy nightmare? And on the deprescribing front, where do you stand: Is it a necessary shift to prevent harm, or could it leave patients vulnerable? Share your opinions in the comments—we'd love to hear differing views!
