The Management of Co-Morbidities in Patients with Heart Failure – Hypertension

2019

Heart failure (HF) is a complex clinical syndrome resulting from structural or functional cardiac disorders. In the developed world, HF is primarily a disorder of the elderly. It is one that is accompanied by many non-cardiac comorbidities that affect treatments given, the patient’s response and treatment tolerance and outcomes. Even the pathophysiological mechanisms of HF change as we look at older patient populations. Younger HF patients typically have ischaemic heart disease and HF with reduced ejection fraction (HFrEF), whereas older patients have more hypertension HF with preserved ejection fraction (HFpEF). The prevalence of HF has progressively increased for many years and rises even more steeply with age. The outcomes of older especially HFpEF patients have not progressed as much younger HFrEF cohorts. We need more studies specifically recruiting older HF patients with more comorbidities, to guide real-world practice, and we need more assessment of patient-reported outcomes and quality of life rather than just mortality effects. The management of elderly patients with HF requires a more holistic approach recognizing individual needs and necessary support mechanisms and our future trials need to guide us more in achieving these gains.

Section: The Effects Of Comorbiditiesmentioning

confidence: 99%

Ageing, demographics, and heart failure

2019

“…Although we preach that age should not be a factor when considering which HF treatments to prescribe, in registry after registry we see it still is, largely because the major trials excluded real-world older patients with multiple comorbidities 6–8 . Among older HF patients, women and comorbidities predominate, including hypertension, 9 diabetes, 10 lung disease, 11 coronary disease, 12 renal failure, 13 sleep disordered breathing, 14 , 15 anaemia, 16 and iron deficiency predominate 17 . The older patient, in addition to not being in the trials, is often more prone to polypharmacy, medication errors, and side effects 18 .…”

Section: Epidemiology and The Effects Of Agementioning

confidence: 99%

“…Like the elderly, women have been significantly less commonly entered into clinical trials. For such patients, elderly with HFpEF there is no established life-saving therapy at all, and the therapeutic strategy is focused on control of HF symptoms and treatment of comorbidities 9 , 12 , 32 . In addition many confounding comorbidities make treatment more difficult; these include iron deficiency, 33 muscle wasting, 20 , 21 and frailty, many making drug side effects 18 more likely.…”

Section: Drug Therapy In the Older Or Frail Hf Patientmentioning

confidence: 99%

Heart failure management of the elderly patient: focus on frailty, sarcopaenia, cachexia, and dementia: conclusions

2019

With the ageing of populations heart failure is becoming more common and more complex. It is affecting ever older patients and the number of prevalent comorbidities is rising. Even as we continue to gain success in large-scale clinical trials with more effective therapies so our patients are becoming more complex. One of the biggest challenges is the effect of age. Frailty, comorbidity, sarcopaenia, cachexia, polypharmacy, and cognitive decline are all challenging our patients as never before and these challenges will be difficult for cash strapped health care systems to manage. For these reasons, the Heart Failure Association brought together a panel of experts to debate and review this complex area, championing the need for us to establish better ways of caring for the patients of the future.

Monitoring for sleep-disordered breathing in heart failure

2019

Sleep-disordered breathing (SDB) is extremely common in heart failure (HF) and it carries with it adverse symptoms and impaired survival. Sleep-disordered breathing has two main types; obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), which can overlap. The differentiation between CSA and OSA is important and is recommended in recent HF guidelines, by recommending a formal sleep study. The reason is that for OSA the main therapy is a positive pressure airway mask, whereas for patients with HFrEF and CSA this mask therapy actually increases cardiovascular mortality, and therefore alternative therapies are required, such as implantable phrenic nerve stimulation to improve sleep and related daytime symptoms attributable to the CSA. This article discusses the detection, screening, and monitoring of SDB in HF patients.