Heart Failure in the Elderly: Advances and Challenges

Bodh I Jugdutt

Disclosures

Expert Rev Cardiovasc Ther. 2010;8(5):695-715. 

In This Article

Abstract and Introduction

Abstract

The elderly population (age ≥65 years) is increasing, and with it the prevalence of heart failure and associated morbidity, hospitalizations and costs. Despite advances, clinical trial data on heart failure therapy exclusively for elderly patients are lacking. However, trials of therapy for heart failure with left ventricular systolic dysfunction or low ejection fraction in primarily non-elderly patients showed mortality benefit in elderly patients. By contrast, trials for heart failure with normal left ventricular systolic function or preserved ejection fraction have not shown mortality benefit in elderly or non-elderly patients. Heart failure pharmacotherapy in the elderly is challenging; it needs to be individualized and consider aging-specific changes in physiology, drug metabolism, drug pharmacokinetics and tolerance, comorbidities, polypharmacy and drug–drug interactions that can contribute to adverse effects. More research into the biology of aging and clinical trials in elderly patients may lead to the discovery of new therapies for heart failure in the elderly.

Introduction

Heart failure (HF) is a major healthcare burden in developed countries and a particularly important problem in the elderly (age ≥65 years).[1] There are at least five reasons for this. First, HF is a progressive disorder, commonly the end-stage in a cardiovascular disease (CVD) continuum (Figure 1) and a common cause of hospitalization in elderly patients. Second, the elderly population is increasing steadily and is particularly prone to HF owing in most part to biological factors and comorbid conditions associated with aging.[2,3] Third, improved CVD therapies, especially those for myocardial infarction (MI) and hypertension, have increased the number of younger patients (i.e., age <65 years) who survive into old age, thereby increasing the toll of HF-prone elderly patients.[1,4–6] Fourth, coronary heart disease (CHD) is common in the elderly and a common cause of HF besides hypertension.[1,7] Fifth, MI is more common in the elderly,[1] and ST-segment elevation MI (STEMI) is especially serious as it leads to more severe left ventricular (LV) dysfunction, adverse remodeling and HF in elderly than non-elderly patients.[3,8] HF in the elderly therefore warrants attention and novel treatment strategies. This article focuses on HF in the elderly, therapeutic advances and challenges.

Figure 1.

Heart failure, aging and the cardiovascular disease continuum. Heart failure can be considered as a progressive disorder in a disease continuum occurring in parallel with aging and leading to disability and ultimate death. Progressive changes during aging and the cardiovascular disease continuum contribute to swell the heart failure burden in the elderly.
AGE: Advanced glycation end product; CV: Cardiovascular; EF: Ejection fraction; HF: Heart failure; LV: Left ventricular; PEF: Preserved ejection fraction.

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