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STEMI and heart failure in the elderly: role of adverse remodeling

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Abstract

The elderly population (age ≥ 65 years) has been increasing worldwide. In North America and Europe, both heart failure (HF) and ST-segment elevation MI (STEMI) are more prevalent in the elderly. Morbidity, hospitalizations and costs associated with HF are higher in the elderly. Despite improved therapies, the bulk of cardiovascular deaths occur in the elderly. Survivors of acute STEMI develop progressive ventricular remodeling that leads to HF. There are several reasons for the increased HF burden in the elderly. First, there is a lack of clinical trial data exclusively in elderly patients for specific therapy of adverse remodeling post-STEMI and HF with low ejection fraction (HF/low-EF) or HF with preserved ejection fraction (HF/PEF). Second, there is the lack of data on the impact of aging on remodeling during healing post-STEMI and HF. Third, HF therapy in the elderly is more challenging because of aging-specific biological changes and associated comorbidities and polypharmacy. More research on aging and post-STEMI remodeling and clinical trials on post-STEMI remodeling and HF in the elderly are needed, especially in the “older-elderly” population segment aged ≥75 years.

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References

  1. Lloyd-Jones D, Adams RJ, Brown TM et al (2010) Heart disease and stroke statistics—2010 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 121:e1–e170

    Article  Google Scholar 

  2. Bureau (2007) UC. U.S. Census Bureau, 2007, U.S. Interim Projections by age

  3. Rich MW (2006) Epidemiology, clinical features, and prognosis of acute myocardial infarction in the elderly. Am J Geriatr Cardiol 15:7–11

    Article  PubMed  Google Scholar 

  4. Hunt SA, Abraham WT, Chin MH et al (2005) ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Writing committee to update the 2001 guidelines for the evaluation and management of heart failure). Circulation 112:e154–e235

    Article  PubMed  Google Scholar 

  5. Jessup M, Abraham WT, Casey DE et al (2009) 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119:1977–2016

    Article  PubMed  Google Scholar 

  6. Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Eur J Heart Fail 10:933–989

    Article  PubMed  Google Scholar 

  7. Alexander KP, Newby LK et al (2007) Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 115:2570–2589

    Article  PubMed  Google Scholar 

  8. Jugdutt BI (2008) Aging and remodeling during healing of the wounded heart: current therapies and novel drug targets. Curr Drug Targets 9:325–344

    Article  CAS  PubMed  Google Scholar 

  9. St John Sutton M, Pfeffer MA et al (1997) Cardiovascular death and left ventricular remodeling two years after myocardial infarction: baseline predictors and impact of long-term use of captopril: information from the Survival and Ventricular Enlargement (SAVE) trial. Circulation 96:3294–3299

    CAS  PubMed  Google Scholar 

  10. McMurray JJ, Stewart S (2000) Epidemiology, aetiology, and prognosis of heart failure. Heart 83:596–602

    Article  CAS  PubMed  Google Scholar 

  11. Mendez GF, Cowie MR (2001) The epidemiological features of heart failure in developing countries: a review of the literature. Int J Cardiol 80:213–219

    Article  CAS  PubMed  Google Scholar 

  12. World Health Organization (WHO) (2009) Definition of an older or elderly person. http://www.who.int/healthinfo/survey/ageingdefnolder/en/print.html. Accessed 30 Dec 2009

  13. Lloyd-Jones DM, Larson MG, Leip EP et al (2002) Framingham Heart Study. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation 106:3068–3072

    Article  PubMed  Google Scholar 

  14. McCullough PA, Khandelwal AK, McKinnon JE et al (2005) Outcomes and prognostic factors of systolic as compared with diastolic heart failure in urban America. Congest Heart Fail 11:6–11

    Article  PubMed  Google Scholar 

  15. McDonald K (2008) Diastolic heart failure in the elderly: underlying mechanisms and clinical relevance. Int J Cardiol 125:197–202

    Article  PubMed  Google Scholar 

  16. Tehrani F, Phan A, Chien CV et al (2009) Value of medical therapy in patients >80 years of age with heart failure and preserved ejection fraction. Am J Cardiol 103:829–833

    Article  PubMed  Google Scholar 

  17. Weisfeldt ML (1980) The aging heart. Its function and response to stress, vol 12. Raven Press, New York

    Google Scholar 

  18. Lakatta E (2003) Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises. Parts I, II and III. Circulation 107:139–146; 346–354; 490–497

    Google Scholar 

  19. Cheitlin MD, Zipes DP (2001) Cardiovascular disease in the elderly. In: Zipes DP, Libby P (eds) Braunwald’s Heart Disease. A textbook of cardiovascular medicine, vol 2. Saunders Elsevier, Philadelphia, pp 2019–2037

    Google Scholar 

  20. Schwartz JB, Zipes DP (2008) Cardiovascular disease in the elderly. In: Libby P, Bonow RO, Mann DL, Zipes DP (eds) Braunwald’s Heart Disease. A textbook of cardiovascular medicine, vol 2. Saunders Elsevier, Philadelphia, pp 1923–1953

    Google Scholar 

  21. Johansen H, Strauss B, Arnold JMO, Moe G, Liu P (2003) On the rise: the current and projected future burden of congestive heart failure hospitalization in Canada. Can J Cardiol 19:430–435

    PubMed  Google Scholar 

  22. Fox KF, Cowie MR, Wood DA et al (2001) Coronary artery disease as the cause of incident heart failure in the population. Eur Heart J 22:228–236

    Article  CAS  PubMed  Google Scholar 

  23. Liu P, Arnold JMO, Belenkie I et al (2001) The 2001 Canadian Cardiovascular Society consensus guideline update for the management and prevention of heart failure. Can J Cardiol 17:5E–25E

    PubMed  Google Scholar 

  24. Jugdutt BI (1990) Identification of patients prone to infarct expansion by the degree of regional shape distortion on an early two-dimensional echocardiogram after myocardial infarction. Clin Cardiol 13:28–40

    Article  CAS  PubMed  Google Scholar 

  25. Jugdutt BI, Tang SB, Khan MI, Basulado CA (1992) Functional impact of remodeling during healing after non-Q wave versus Q wave anterior myocardial infarction in the dog. J Am Coll Cardiol 20:722–731

    Article  CAS  PubMed  Google Scholar 

  26. Jugdutt BI, Khan MI (1992) Impact of increased infarct transmurality on remodelling and function during healing after anterior myocardial infarction in the dog. Can J Physiol Pharmacol 70:949–958

    CAS  PubMed  Google Scholar 

  27. Boesma E, Mercado N, Poldermans D et al (2003) Acute myocardial infarction. Lancet 361:847–858

    Article  Google Scholar 

  28. Reimer KA, Lowe JE, Ramussen MM et al (1977) The wavefront phenomenon of ischemic cell death, 1: myocardial infarct size versus duration of coronary occlusion in dogs. Circulation 56:786–794

    CAS  PubMed  Google Scholar 

  29. Jugdutt BI (1993) Prevention of ventricular remodelling post myocardial infarction: timing and duration of therapy. Can J Cardiol 9:103–114

    CAS  PubMed  Google Scholar 

  30. Mann DL (2008) Management of heart failure patients with reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Zipes DP (eds) Braunwald’s Heart Disease. A textbook of cardiovascular medicine, vol 1. Saunders Elsevier, Philadelphia, USA, pp 611–640

    Google Scholar 

  31. Pfeffer MA, Braunwald E (1990) Ventricular remodelling after myocardial infarction. Circulation 81:1161–1172

    CAS  PubMed  Google Scholar 

  32. Goldberg RJ, McCormick D, Gurwitz JH et al (1998) Age-related trends in short- and long-term survival after acute myocardial infarction: a 20-year population-based perspective (1975–1995). Am J Cardiol 82:1311–1317

    Article  CAS  PubMed  Google Scholar 

  33. White HD, Barbash GI, Califf RM et al (1996) Age and outcome with contemporary thrombolytic therapy. Results from the GUSTO-I trial. Global utilization of streptokinase and TPA for occluded coronary arteries trial. Circulation 94:1826–1833

    CAS  PubMed  Google Scholar 

  34. Stone PH, Thompson B, Anderson HV et al (1996) Influence of race, sex, and age on management of unstable angina and non-Q-wave myocardial infarction: the TIMI III registry. JAMA 275:1104–1112

    Article  CAS  PubMed  Google Scholar 

  35. Rich MW, Bosner MS, Chung MK et al (1992) Is age an independent predictor of early and late mortality in patients with acute myocardial infarction? Am J Med 92:7–13

    Article  CAS  PubMed  Google Scholar 

  36. Goldberg RJ, Yarzebski J, Lessard D, Gore JM (1999) A two-decades (1975 to 1995) long experience in the incidence, in-hospital and long-term case-fatality rates of acute myocardial infarction: a community-wide perspective. J Am Coll Cardiol 33:1533–1539

    Article  CAS  PubMed  Google Scholar 

  37. Ezekowitz JA, Kaul P, Bakal JA et al (2009) Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction. J Am Coll Cardiol 53:13–20

    Article  PubMed  Google Scholar 

  38. Krumholz HM, Wang Y, Chen J et al (2009) Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995–2006. JAMA 302:767–773

    Article  CAS  PubMed  Google Scholar 

  39. Boersma E, The Primary Coronary Angioplasty vs. Thrombolysis (PCAT)-2 Trialists’ Collaborative Group (2006) Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. Eur Heart J 27:779–788

    Article  PubMed  Google Scholar 

  40. Goldenberg I, Matetzky S, Halkin A et al (2003) Primary angioplasty with routine stenting compared with thrombolytic therapy in elderly patients with acute myocardial infarction. Am Heart J 145:862–867

    Article  PubMed  Google Scholar 

  41. de Boer MJ, Ottervanger JP, van ‘t Hof AW et al (2002) Reperfusion therapy in elderly patients with acute myocardial infarction: a randomized comparison of primary angioplasty and thrombolytic therapy. J Am Coll Cardiol 39:1723–1728

    Article  PubMed  Google Scholar 

  42. Bolognese L, Neskovic AN et al (2002) Left ventricular remodeling after primary coronary angioplasty: patterns of left ventricular dilation and long-term prognostic implications. Circulation 106:2351–2357

    Article  PubMed  Google Scholar 

  43. Wenger N (1993) Inclusion of elderly individuals in clinical trials. In: Wenger N (ed) Proceedings cardiovascular disease and cardiovascular therapy as a model. Marion Merrell Dow, Inc, Kansas

    Google Scholar 

  44. Alexander KP, Newby LK, Cannon CP et al (2007) Acute coronary care in the elderly, part I: non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 115:2549–2569

    Article  PubMed  Google Scholar 

  45. Lee PY, Alexander KP, Hammill BG, Pasquali SK, Peterson ED (2001) Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA 286:708–713

    Article  CAS  PubMed  Google Scholar 

  46. Gurwitz JH, Col NF, Avorn J (1992) The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA 268:1417–1422

    Article  CAS  PubMed  Google Scholar 

  47. Nicolosi GL, Golcea S, Ceconi C et al (2009) Effects of perindopril on cardiac remodelling and prognostic value of pre-discharge quantitative echocardiographic parameters in elderly patients after acute myocardial infarction: the PREAMI echo substudy. Eur Heart J 30:1656–1665

    Article  CAS  PubMed  Google Scholar 

  48. Bujak M, Kweon HJ et al (2008) Aging-related defects are associated with adverse cardiac remodeling in a mouse model of reperfused myocardial infarction. J Am Coll Cardiol 51:1384–1392

    Article  PubMed  Google Scholar 

  49. Jugdutt BI, Jelani AW (2008) Aging and defective healing, adverse remodeling, and blunted post-conditioning in the reperfused wounded heart. J Am Coll Cardiol 51:1399–1403

    Article  PubMed  Google Scholar 

  50. Przyklenk K, Maynard M, Darling CE, Whittaker P (2008) Aging mouse hearts are refractory to infarct size reduction with post-conditioning. J Am Coll Cardiol 51:1393–1398

    Article  PubMed  Google Scholar 

  51. Jugdutt BI (2007) Cyclooxygenase inhibition and adverse remodeling during healing after myocardial infarction. Circulation 115:288–291

    Article  PubMed  Google Scholar 

  52. Maggioni AP, Maseri A, Fresco C et al (1993) Age-related increase in mortality among patients with first myocardial infarctions treated with thrombolysis. The Investigators of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI-2). New Engl J Med 329:1442–1448

    Article  CAS  PubMed  Google Scholar 

  53. Bueno H, Martinez-Selles M, Perez-David E, Lopez-Palop R (2005) Effect of thrombolytic therapy on the risk of cardiac rupture and mortality in older patients with first acute myocardial infarction. Eur Heart J 26:1705–1711

    Article  CAS  PubMed  Google Scholar 

  54. Gurwitz JH, McLaughlin TJ, Willison DJ et al (1997) Delayed hospital presentation in patients who have had acute myocardial infarction. Ann Intern Med 126:593–599

    CAS  PubMed  Google Scholar 

  55. Yarzebski J, Goldberg RJ, Gore JM, Alpert JS (1994) Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarction: the Worcester Heart Attack Study. Am Heart J 128:255–263

    Article  CAS  PubMed  Google Scholar 

  56. Goldberg RJ, Yarzebski J, Lessard D, Gore JM (2000) Decade-long trends and factors associated with time to hospital presentation in patients with acute myocardial infarction: the Worcester Heart Attack study. Arch Int Med 160:3217–3223

    Article  CAS  Google Scholar 

  57. Moser DK, Kimble LP, Alberts MJ et al (2006) Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association Council on cardiovascular nursing and stroke council. Circulation 114:168–182

    Article  PubMed  Google Scholar 

  58. Lee KL, Woodlief LH, Topol EJ et al (1995) Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41, 021 patients. GUSTO-I Investigators. Circulation 91:1659–1668

    CAS  PubMed  Google Scholar 

  59. Woon VC, Lim KH (2003) Acute myocardial infarction in the elderly—the differences compared with the young. Singapore Med J 44:414–418

    CAS  PubMed  Google Scholar 

  60. Newby LK, Rutsch WR, Califf RM et al (1996) Time from symptom onset to treatment and outcomes after thrombolytic therapy. GUSTO-1 Investigators. J Am Coll Cardiol 27:1646–1655

    Article  CAS  PubMed  Google Scholar 

  61. Dzavik V, Sleeper LA, Picard MH et al (2005) Outcome of patients aged > or = 75 years in the SHould we emergently revascularize occluded coronaries in cardiogenic shocK (SHOCK) trial: do elderly patients with acute myocardial infarction complicated by cardiogenic shock respond differently to emergent revascularization? Am Heart J 149:1128–1134

    Article  PubMed  Google Scholar 

  62. Sinkovic A, Marinsek M, Svensek F (2006) Women and men with unstable angina and/or non-ST-elevation myocardial infarction. Wien Klin Wochenschr 118(Suppl 2):52–57

    Article  PubMed  Google Scholar 

  63. Khalil ME, Heller EN, Boctor F et al (2001) Ventricular free wall rupture in acute myocardial infarction. J Cardiovasc Pharmacol Ther 6:231–236

    Article  CAS  PubMed  Google Scholar 

  64. Hellermann JP, Jacobsen SJ, Reeder GS et al (2003) Heart failure after myocardial infarction: prevalence of preserved left ventricular systolic function in the community. Am Heart J 145:742–748

    Article  PubMed  Google Scholar 

  65. Michaels AD (1997) Risk of stroke after myocardial infarction. N Engl J Med 336:1916–1917

    Article  CAS  PubMed  Google Scholar 

  66. Ertl G, Frantz S (2005) Healing after myocardial infarction. Cardiovasc Res 66:22–32

    Article  CAS  PubMed  Google Scholar 

  67. Jugdutt BI (2003) Ventricular remodeling after infarction and the extracellular collagen matrix: when is enough enough? Circulation 108:1395–1403

    Article  PubMed  Google Scholar 

  68. Rathore SS, Berger AK, Weinfurt KP et al (2000) Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. Circulation 101:969–974

    CAS  PubMed  Google Scholar 

  69. Avezum A, Makdisse M, Spencer F et al (2005) Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J 149:67–73

    Article  PubMed  Google Scholar 

  70. Skolnick AH, Alexander KP, Chen AY et al (2007) Characteristics, management, and outcomes of 5,557 patients age > or = 90 years with acute coronary syndromes: results from the CRUSADE Initiative. J Am Coll Cardiol 49:1790–1797

    Article  PubMed  Google Scholar 

  71. Jugdutt BI (2010) Heart failure in the elderly: advances and challenges. Expert Rev Cardiovasc Ther (in press)

  72. Paulus WJ, Tschöpe C, Sanderson JE et al (2007) How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 28:2539–2550

    Article  PubMed  Google Scholar 

  73. Redfield MM (2008) Heart failure with normal ejection fraction. In: Libby P, Bonow RO, Mann DL, Zipes DP (eds) Braunwald’s Heart Disease. A textbook of cardiovascular medicine, vol 1. Saunders Elsevier, Philadelphia, pp 641–664

    Google Scholar 

  74. Masoudi FA, Havranek EP, Smith G et al (2003) Gender, age, and heart failure with preserved left ventricular systolic function. J Am Coll Cardiol 41:217–223

    Article  PubMed  Google Scholar 

  75. Larsen PD, Martin JL (1999) Polypharmacy and elderly patients. AORN J 69:619–622, 25, 27–8

    Google Scholar 

  76. Jones BA (1997) Decreasing polypharmacy in clients most at risk. AACN Clin Issues 8:627–634

    Article  CAS  PubMed  Google Scholar 

  77. Jugdutt BI (2010) Aging and heart failure: changing demographics and implications for therapy in the elderly. Heart Fail Rev (in press)

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Acknowledgments

This work was supported in part by grant # IAP99003 from the Canadian Institutes of Health Research, Ottawa, Ontario. We are indebted to Catherine Jugdutt for assistance.

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  1. 2C2 Walter MacKenzie Health Sciences Centre, Division of Cardiology, Department of Medicine and Cardiovascular Research Group, Faculty of Medicine, University of Alberta Hospital, Edmonton, AB, T6G 2R7, Canada

    Anwar Jelani & Bodh I. Jugdutt

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  1. Anwar Jelani
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Correspondence to Bodh I. Jugdutt.

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Jelani, A., Jugdutt, B.I. STEMI and heart failure in the elderly: role of adverse remodeling. Heart Fail Rev 15, 513–521 (2010). https://doi.org/10.1007/s10741-010-9177-3

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