New horizons in management of heart failure in older patients

Abstract

Heart failure has a high prevalence in older populations, is a common and growing cause for hospital admission and carries a high risk of morbidity and mortality. Important co-morbidities in older patients with heart failure include atrial fibrillation, renal impairment, hypertension and anaemia. Diagnosing and managing heart failure in older patients are complicated due to atypical presentations, co-morbidities and a relative lack of evidence for commonly used treatments in younger patients. The growing epidemic of heart failure is also under-recognised and resourced in most health systems. Despite potential differences, we recommend that the basic approach to manage heart failure patients with an ejection fraction (EF) of <40% should be the same in older and younger. These treatments need to be started at low doses and titrated slowly along with the management of co-morbidities. Older patients with EF 40–49% can be treated in a similar manner to those with <40%, while the treatment of those with EF ≥50% is pragmatic in nature based on symptom control and management of co-morbidities although the evidence base for these recommendations is lacking. Overall management must be holistic and continuous based on the patient’s social circumstances and ongoing needs. Finally, there is an urgent need for more research, evidence and resources directed towards older populations with heart failure to improve their care and the quality of life.

Prognostic value of functional capacity after transitional rehabilitation in older patients hospitalized for heart failure

“…In the recent REHAB‐HF trial, 20 a transitional rehabilitation intervention resulted in greater improvement in physical function than usual care in older patients hospitalized for HF. Our findings, by showing that the level of functional capacity achieved after transitional CR is closely associated with long‐term survival, add to the REHAB‐HF trial results and provide further supportive evidence for prioritizing improvement in functional capacity as a therapeutic target in older patients hospitalized for 45 …”

“…Our findings, by showing that the level of functional capacity achieved after transitional CR is closely associated with long-term survival, add to the REHAB-HF trial results and provide further supportive evidence for prioritizing improvement in functional capacity as a therapeutic target in older patients hospitalized for. 45 Limitations Some limitations must be acknowledged. First, this study was retrospective in nature.…”

Global historical retrospect and future prospects on biomarkers of heart failure: A bibliometric analysis and science mapping

“…Heart failure (HF) is a fast-growing public health challenge, affecting about 40 million people worldwide and becoming the main cause of hospitalization among middle-aged and elderly people [ 1 , 2 ]. The American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) define HF as " a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood” [ 3 ].…”

Polypharmacy in Older People with Heart Failure: Roles of the Geriatrician and Pharmacist

“…Depending on the availability of beds in the cardiology ward, older people with HF may also be admitted to either a general medical ward or a care of the older person ward rather than a cardiology or HF specialist unit, which means that geriatricians and general medical practitioners are often at the core of delivering cardiovascular care for this group of people. [ 60 ] As such, despite the stresses and time pressures placed on hospital-based clinicians, and notwithstanding the importance of a proactive primary care physician, it could be argued that geriatricians are well placed to conduct a thorough medication review on older people with HF admitted to hospital at some point during the inpatient stay. However, this is a task that ought to be conducted by all clinicians and not limited to geriatricians.…”