Heart failure management in the elderly – a public health challenge

Abstract

Heart failure (HF) is a rapidly growing public health problem and the leading cause of morbidity, mortality, and hospitalization in populations > 65 years. The elderly HF patients have an increased prevalence of HF with preserved ejection fraction and comorbidities, may present with atypical symptoms and signs, have a higher risk for adverse drug reactions, and worse prognosis as compared with younger patients. Moreover, there is a lack of evidence-based therapies for this population because they are underrepresented in the clinical trials. The elderly are less likely to be evaluated by a cardiologist and to be treated in accordance with recommendations of the current HF guidelines. Although the treatment is improving, it is still suboptimal; therefore, HF in elderly patients requires mobilization of public health services and improvement of treatment strategies.

Risk factors for poor prognosis in heart failure with particular attention to the elderly population

“…It is well-known that elderly patients often present with complex comorbidities (hypertension, CAD, atrial fibrillation, peripheral vascular disease, kidney failure, or anemia) compared to the younger population [5,26]. We confirmed this observation in our study (Table 4).…”

“…During the last twenty years, it was established that a significant percentage of patients with HF, especially the elderly, have preserved left ventricular systolic function [5,21,26,35]. The latest HF guidelines published by the European Society of Cardiology [8] distinguish HF with LVEF that is significantly reduced (< 40%), moderately reduced (LVEF 40-49%) and preserved (≥ 50%).…”

“…Despite significant advancements in the pharmacological and invasive treatment of HF, based on the widespread use of implantable cardioverter-defibrillators and resynchronization therapy to reduce mortality, the morbidity and mortality are still high [2][3][4]. HF exacerbation is the leading cause of hospital admissions [5], thus a considerable health burden for patients and the health care system [6][7]. Patients hospitalized due to HF exacerbation are known to have the worst prognosis [1,4].…”

Cardiovascular drug use among people with cognitive impairment living in nursing homes in northern Sweden

“…Underrepresentation in studies and less contact with specialist care are possible reasons for the sparse evidence for disease management of heart failure in elderly people [9]. These people often have multiple comorbidities, polypharmacy [12][13][14] and a worse prognosis than do younger people [9,14].…”

Micronutrient Depletion in Heart Failure: Common, Clinically Relevant and Treatable

“…Heart failure (HF) is a complex disease with many potential underlying causes, which affects the function of other tissues and is often followed by comorbidities [1], especially in the elderly [2]. Pathogenesis of HF has been elucidated and includes many mechanisms, such as increased hemodynamic overload, ischemic-related dysfunction, ventricular remodeling, excessive neurohormonal stimulation, abnormal cardiomyocyte calcium cycling, excessive or inadequate accumulation of extracellular matrix, accelerated apoptosis, and genetic mutations [1].…”