Assessment of Heart Failure in Older Adults
Assessment of HF in older adults can be summarized and simplified by the mnemonic DEFEAT-HF. D stands for diagnosis: HF is a clinical diagnosis; a clinical diagnosis of HF must be made before echocardiography is ordered as about half of all older adults with HF have normal left ventricular ejection fraction. E represents etiology: HF is a syndrome and not a disease, so an underlying etiology must be determined. This is important as there may be an ongoing ischemia causing further myocardial damage. F indicates fluid volume: the assessment of fluid volume is essential to achieving and maintaining euvolemia, which is needed to reduce hospitalization and improve patients’ quality of life. Further, life-saving therapies such as beta-blockers are ideally initiated when patients are stable and euvolemic. Fluid volume status can be most reliably assessed by estimating jugular venous pressure at the neck. EA stands for ejection fraction: an estimation of ejection fraction, most commonly via echocardiography, is the single most important test after a clinical diagnosis of HF has been made. This is important for both prognostic and therapeutic reasons. Persons with systolic HF generally have a poorer prognosis than do those with diastolic HF or clinical HF with a normal or near-normal ejection fraction. However, the poor prognosis of systolic HF can be favourably modified by the appropriate use of life-saving drugs such as angiotensin-converting enzyme inhibitors (ACEIs) or beta-blockers. T represents treatment: treatment of HF is rapidly evolving, and clinicians should follow the recommendations of a national HF guideline.[2,6]
Geriatrics and Aging. 2008;11(1):37-41. © 2008 1453987 Ontario, Ltd.
Cite this: An Update on the Role of Digoxin in Older Adults with Chronic Heart Failure - Medscape - Jan 01, 2008.