Heart Failure in Older Patients
Heart Failure in Older Patients
As the population ages, so the prevalence of chronic heart failure (CHF) will rise. The majority of CHF patients in the future will be elderly, yet most of our current evidence for the management of this serious condition arises from trials that have largely excluded older patients. As a consequence, older patients who may derive the greatest benefit from treatments known to reduce morbidity and mortality in CHF, are often denied such treatments. The effects on quality of life of both the syndrome of CHF and its treatment in older CHF patients must be borne in mind, as must issues of compliance, prevalence of comorbidity, and requirement for physical and emotional support. We review the current epidemiology of CHF, and focus on the applicability and use of contemporary non- pharmacological and pharmacological therapy to older patients with CHF. The potential use of devices and surgery in older CHF patients is also discussed.
Chronic heart failure (CHF) is a clinical syndrome that can result from any cardiac disorder that impairs the ability of the heart to deliver adequate cardiac output during exercise or rest. Whether it is defined as the symptomatic syndrome, or widened to incorporate asymptomatic left ventricular systolic dysfunction (LVSD), CHF is a growing clinical problem. The population is ageing - in 2000 it was estimated that more than 25% of the European population was older than 65 years, with significant increases in life expectancy noted at all ages (from 14.9-18.9 at 65 years, to 6.9-9.1 at 80 years). With improved diagnosis and treatment of hypertension, and primary and secondary preventive treatment of ischaemic heart disease (IHD) - the two main precursors of CHF - the inevitable consequence will be increased numbers of elderly 'survivors' at risk of developing CHF. Most of the major clinical trials in CHF have excluded the very elderly, and application of current evidence to this population is fraught with difficulty. It is important to focus current thinking on older patients, as they will constitute the majority of our CHF patients in the future.
Abstract and Introduction
Abstract
As the population ages, so the prevalence of chronic heart failure (CHF) will rise. The majority of CHF patients in the future will be elderly, yet most of our current evidence for the management of this serious condition arises from trials that have largely excluded older patients. As a consequence, older patients who may derive the greatest benefit from treatments known to reduce morbidity and mortality in CHF, are often denied such treatments. The effects on quality of life of both the syndrome of CHF and its treatment in older CHF patients must be borne in mind, as must issues of compliance, prevalence of comorbidity, and requirement for physical and emotional support. We review the current epidemiology of CHF, and focus on the applicability and use of contemporary non- pharmacological and pharmacological therapy to older patients with CHF. The potential use of devices and surgery in older CHF patients is also discussed.
Introduction
Chronic heart failure (CHF) is a clinical syndrome that can result from any cardiac disorder that impairs the ability of the heart to deliver adequate cardiac output during exercise or rest. Whether it is defined as the symptomatic syndrome, or widened to incorporate asymptomatic left ventricular systolic dysfunction (LVSD), CHF is a growing clinical problem. The population is ageing - in 2000 it was estimated that more than 25% of the European population was older than 65 years, with significant increases in life expectancy noted at all ages (from 14.9-18.9 at 65 years, to 6.9-9.1 at 80 years). With improved diagnosis and treatment of hypertension, and primary and secondary preventive treatment of ischaemic heart disease (IHD) - the two main precursors of CHF - the inevitable consequence will be increased numbers of elderly 'survivors' at risk of developing CHF. Most of the major clinical trials in CHF have excluded the very elderly, and application of current evidence to this population is fraught with difficulty. It is important to focus current thinking on older patients, as they will constitute the majority of our CHF patients in the future.
