Skip to main content
Log in

Heart Failure in Very Old Adults

  • Epidemiology of Heart Failure (J Butler, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Heart failure (HF) increases significantly in relation to advancing age, yet management for HF in very old adults remains ambiguous. With aging, not only do age-related, morphological and physiological cardiovascular changes predispose to HF, there is also increased prevalence of comorbid conditions that compound cardiac limitations (e.g., renal insufficiency and chronic obstructive lung disease) and others that tend to overwhelm limited cardiovascular reserves (e.g., infections and ischemia). Standard HF pharmacological and device therapies do little to moderate the wide spectrum of insidious age-related processes that are elemental to HF pathophysiology among older patients. Moreover, the utility of standard HF therapy is usually premised on its efficacy for life prolongation, whereas quality of life, increased physical and cognitive function, and preserved independence may be regarded as higher (or even highest) priority. In this review we study age-related susceptibility to HF, as well as the utility and limitations of standard HF strategies. Both HF with reduced ejection fraction and HF with preserved ejection fraction are considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Forman DE, Rich MW, Alexander KP, Zieman S, Maurer MS, Najjar SS, et al. Cardiac care for older adults. Time for a new paradigm. J Am Coll Cardiol. 2011;57:1801–10. Transformative perspective on why aging changes the dimensions of cardiovascular care.

    PubMed  Google Scholar 

  2. Kannel W. J Clin Epidemiol. 2000;53:229–35.

    PubMed  CAS  Google Scholar 

  3. •• Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part I: aging arteries: a “set up” for vascular disease. Circulation. 2003;107:139–46. Important overview of the interrelationship between vascular aging and increased vulnerability to disease among older adults.

    PubMed  Google Scholar 

  4. •• Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part II: the aging heart in health: links to heart disease. Circulation. 2003;107:346–54. Important overview of the interrelationship between cardiac aging and increased vulnerability to disease among older adults.

    PubMed  Google Scholar 

  5. •• Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A, et al. Lifetime risks of cardiovascular disease. N Engl J Med. 2012;366(4):321–9. Key perspective on why the dimension of time is a critical determinant of the impact of cardiac risk factors; risk is cumulative over the decades of a lifetime.

    PubMed  CAS  Google Scholar 

  6. Lakatta EG, Wang M, Najjar S. Arterial aging and subclinical arterial disease are fundamentally inter twined at macroscopic and molecular levels. Med Clin North Am. 2009;93:583.

    PubMed  CAS  Google Scholar 

  7. Rich MW. Heart failure in the 21st century: a cardiogeriatric syndrome. J Gerontol A Biol Sci Med Sci. 2001;56:M88–96.

    PubMed  CAS  Google Scholar 

  8. Dodson JA, Chaudhry SI. Geriatric conditions in heart failure. Curr Cardiovasc Risk Rep. 2012;6:404–10.

    PubMed  Google Scholar 

  9. • Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55:780–91. Review of mechanisms underlying geriatric syndromes, and implications for age-related disease management.

    PubMed  Google Scholar 

  10. Kannel WB, Belanger AJ. Epidemiology of heart failure. Am Heart J. 1991;121:951–7.

    PubMed  CAS  Google Scholar 

  11. Gottdiener JS, McClelland RL, Marshall R, et al. Outcome of congestive heart failure in elderly persons: influence of left ventricular systolic function. The Cardiovascular Health Study. Ann Intern Med. 2002;137:631–9.

    PubMed  Google Scholar 

  12. Scantlebury DC, Borlaug BA. Why are women more likely than men to develop heart failure with preserved ejection fraction? Curr Opin Cardiol. 2011;26:562–8.

    PubMed  Google Scholar 

  13. Gillum RF. Epidemiology of heart failure in the United States. Am Heart J. 1993;126:1042–7.

    PubMed  CAS  Google Scholar 

  14. Ho KKL, Anderson KM, Kannel WB, et al. Survival after onset of congestive heart failure in the Framingham Heart Study subjects. Circulation. 1993;88:107–15.

    PubMed  CAS  Google Scholar 

  15. Mahjoub H, Rusinaru D, Souliere V, Durier C, Peltier M, Tribouilloy C. Long-term survival in patients older than 80 years hospitalized for heart failure. A 5-year prospective study. Eur J Heart Fail. 2008;10:78–84.

    PubMed  Google Scholar 

  16. Mogensen UM, Erdsboll M, Andersen M, Andersson C, Hassager C, Torp-Pedersen C, et al. Clinical characteristics and major comorbidities in heart failure patients more than 85 years of age compared with younger age groups. Eur J Heart Fail. 2011;13:1216–23.

    PubMed  Google Scholar 

  17. MacIntyre K, Capewell S, Stewart S, et al. Evidence of improving prognosis in heart failure: trends in case fatality in 66 547 patients hospitalized between 1986 and 1995. Circulation. 2000;102:1126–31.

    PubMed  CAS  Google Scholar 

  18. Chan MM, Lam CS. How do patients with heart failure with preserved ejection fraction die? Eur J Heart Fail. 2013;15(6):604–13.

    PubMed  Google Scholar 

  19. Bursi F, Weston SA, Redfield MM, Jacobsen SJ, Pakhomov S, Nkomo VT, et al. Systolic and diastolic heart failure in the community. JAMA. 2006;296:2209–16.

    PubMed  CAS  Google Scholar 

  20. Rodriguez F, Wang Y, Johnson CE, Foody JM. National patterns of heart failure hospitalizations and mortality by sex and age. J Card Fail. 2013;19(8):542–9.

    PubMed  Google Scholar 

  21. Chen J, Normand SL, Wang Y, Krumholz HM. National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998–2008. JAMA. 2011;306:1669–78.

    PubMed  CAS  Google Scholar 

  22. Hall MJ, Levant S, DeFrances CJ. Hospitalization for congestive heart failure: United States, 2000–2010. NCHS Data Brief. 2012;108:1–8.

    PubMed  Google Scholar 

  23. Ouzounian M, Lee DS, Liu PP. Diastolic heart failure: mechanisms and controversies. Nat Clin Pract Cardiovasc Med. 2008;5:375–86.

    PubMed  Google Scholar 

  24. Wang M, Monticone RE, Lakatta EG. Arterial aging: a journey into subclinical arterial disease. Curr Opin Nephrol Hypertens. 2010;19(2):201–7.

    PubMed  CAS  Google Scholar 

  25. Moslehi J, DePinho RA, Sahin E. Telomeres and mitochondria in the aging heart. Circ Res. 2012;110(9):1226–37.

    PubMed  CAS  Google Scholar 

  26. • Ather S, Chan W, Bozkurt B, Aguilar D, Ramasubbu K, Zachariah AA, et al. Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol. 2012;59:998–1005. Analysis that highlights the key role of comorbidities in HFpEF.

    PubMed  Google Scholar 

  27. Kaila K, Haykowsky MJ, Thompson RB, Paterson DI. Heart failure with preserved ejection fraction in the elderly: scope of the problem. Heart Fail Rev. 2012;17(4–5):555–62.

    PubMed  Google Scholar 

  28. Ohara T, Ohte N, Little WC. Pulmonary hypertension in heart failure with preserved left ventricular ejection fraction: diagnosis and management. Curr Opin Cardiol. 2012;27:281–7.

    PubMed  Google Scholar 

  29. Landi F, Cruz-Jentoft AJ, Liperoti R, Russo A, Giovannini S, Tosato M, et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. 2013;42:203–9.

    PubMed  Google Scholar 

  30. • Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition–multimorbidity. JAMA. 2012;307:2493–4. Valuable insight regarding effects of multimorbidity on CV healthcare.

    PubMed  CAS  Google Scholar 

  31. Alosco ML, Spitznagel MB, van Dulmen M, Raz N, Cohen R, Sweet LH, et al. Cognitive function and treatment adherence in older adults with heart failure. Psychosom Med. 2012;74:965–73.

    PubMed  Google Scholar 

  32. Alosco ML, Garcia S, Spitznagel MB, van Dulmen M, Cohen R, Sweet LH, Josephson R, Hughes J, Rosneck J, Gunstad J. Cognitive performance in older adults with stable heart failure: longitudinal evidence for stability and improvement. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2013.

  33. Blagosklonny MV. Answering the ultimate question “what is the proximal cause of aging?”. Aging (Albany NY). 2012;4:861–77.

    Google Scholar 

  34. Kannel WB. Incidence and epidemiology of heart failure. Heart Fail Rev. 2000;5:167–73.

    PubMed  CAS  Google Scholar 

  35. Alboni P, Scarfò S, Fucà G. Development of heart failure in bradycardic sick sinus syndrome. Ital Heart J. 2001;2:9–12.

    PubMed  CAS  Google Scholar 

  36. Duscha BD, Schulze PC, Robbins JL, Forman DE. Implications of chronic heart failure on peripheral vasculature and skeletal muscle before and after exercise training. Heart Fail Rev. 2008;13:21–37.

    PubMed  Google Scholar 

  37. Regitz-Zagrosek V, Brokat S, Tschope C. Role of gender in heart failure with normal left ventricular ejection fraction. Prog Cardiovasc Dis. 2007;49:241–51.

    PubMed  CAS  Google Scholar 

  38. Devereux RB, Roman MJ, Liu JE, et al. Congestive heart failure despite normal left ventricular systolic function in a population-based sample: the Strong Heart Study. Am J Cardiol. 2000;86:1090–6.

    PubMed  CAS  Google Scholar 

  39. Kannel WB. Epidemiological aspects of heart failure. Cardiol Clin. 1989;7:1–9.

    PubMed  CAS  Google Scholar 

  40. Senni M, Tribouilloy CM, Rodeheffer RJ, et al. Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation. 1998;98:2282–9.

    PubMed  CAS  Google Scholar 

  41. Kitzman DW, Gardin JM, Gottdiener JS, et al. Importance of heart failure with preserved systolic function in patients > or = 65 years of age. CHS Research Group. Cardiovascular Health Study. Am J Cardiol. 2001;87:413–9.

    PubMed  CAS  Google Scholar 

  42. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, et al. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med. 2008;359(23):2456–67.

    PubMed  CAS  Google Scholar 

  43. • Aurigemma GP, Gottdiener JS, Shemanski L, Gardin J, Kitzman D. Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the cardiovascular health study. J Am Coll Cardiol. 2001;37:1042–8. Analysis that highlights the interplay between diastolic and systolic pumping abnormalities in heart failure.

    PubMed  CAS  Google Scholar 

  44. •• Braunstein JB, Anderson GF, Gerstenblith G, Weller W, Niefeld M, Herbert R, et al. Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. J Am Coll Cardiol. 2003;42:1226–33. Study showing that cardiac comorbidities are highly prevalent in older patients with CHF and strongly associated with adverse clinical outcomes.

    PubMed  Google Scholar 

  45. Rich MW, Kitzman DW. Heart failure in octogenarians: a fundamentally different disease. Am J Geriatr Cardiol. 2000;9(Suppl):97–104.

    Google Scholar 

  46. Maestre A, Gil V, Gallego J, Aznar J, Mora A, Martin-Hidalgo A. Diagnostic accuracy of clinical criteria for identifying systolic and diastolic heart failure: cross-sectional study. J Eval Clin Pract. 2009;15:55–61.

    PubMed  Google Scholar 

  47. Ekundayo OJ, Howard VJ, Safford MM, et al. Value of orthopnea, paroxysmal nocturnal dyspnea, and medications in prospective population studies of incident heart failure. Am J Cardiol. 2009;104:259–64.

    PubMed  Google Scholar 

  48. Butman SM, Ewy GA, Standen JR, Kern KB, Hahn E. Bedside cardiovascular examination in patients with severe chronic heart failure: importance of rest or inducible jugular venous distension. J Am Coll Cardiol. 1993;22:968–74.

    PubMed  CAS  Google Scholar 

  49. Ahmed A. Chronic heart failure in older adults. Med Clin North Am. 2011;95:439–61.

    PubMed  Google Scholar 

  50. Hildebrandt P, Collinson PO, Dougherty RN, et al. Age-dependent values of N-terminal pro-B-type natriuretic peptide are superior to a single cut-point for ruling out suspected systolic dysfunction in primary care. Eur Heart J. 2010;31:1881–9.

    PubMed  CAS  Google Scholar 

  51. Lokuge A, Lam L, Cameron P, et al. B-type natriuretic peptide testing and the accuracy of heart failure diagnosis in the emergency department. Circ Heart Fail. 2010;3:104–10.

    PubMed  CAS  Google Scholar 

  52. Pfisterer M, Buser P, Rickli H, et al. BNP-guided vs. symptom-guided heart failure therapy: the Trial of Intensified vs. Standard Medical Therapy in Elderly Patients with Congestive Heart Failure (TIME-CHF) randomized trial. JAMA. 2009;301:383–92.

    PubMed  CAS  Google Scholar 

  53. Laramee P, Wonderling D, Swain S, Al-Mohammad A, Mant J. Cost-effectiveness analysis of serial measurement of circulating natriuretic peptide concentration in chronic heart failure. Heart. 2013;99:267–71.

    PubMed  Google Scholar 

  54. Fleg JL, O’Connor F, Gerstenblith G, et al. Impact of age on the cardiovascular response to dynamic upright exercise in healthy men and women. J Appl Physiol. 1995;78:890–900.

    PubMed  CAS  Google Scholar 

  55. Schulman SP, Lakatta EG, Fleg JL, et al. Age-related decline in left ventricular filling at rest and exercise. Am J Physiol. 1992;263:H1932–8.

    PubMed  CAS  Google Scholar 

  56. Fonarow GC, Abraham WT, Albert NM, et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med. 2008;168:847–54.

    PubMed  Google Scholar 

  57. Taylor DM, Fui MN, Chung AR, Gani L, Zajac JD, Burrell LM. A comparison of precipitants and mortality when acute decompensated heart failure occurs in the community and hospital settings. Heart Lung Circ. 2012;21:439–43.

    PubMed  Google Scholar 

  58. Saczynski JS, Darling CE, Spencer FA, Lessard D, Gore JM, Goldberg RJ. Clinical features, treatment practices, and hospital and long-term outcomes of older patients hospitalized with decompensated heart failure: the Worcester Heart Failure Study. J Am Geriatr Soc. 2009;57:1587–94.

    PubMed  Google Scholar 

  59. Stone J, Hoffman GJ. Medicare hospital readmissions: issues, policy options and PPACA: congressional research service report for congress. Prepared for Members and Committees of Congress. Washington, DC 2010.

  60. Rodriguez-Pascual C, Vilches-Moraga A, Paredes-Galan E, Ferrero-Martinez AI, Torrente-arballido M, Rodriguez-Artalejo F. Comprehensive geriatric assessment and hospital mortality among older adults with decompensated heart failure. Am Heart J. 2012;164:756–62.

    PubMed  Google Scholar 

  61. Goldberg RJ, Spencer FA, Szklo-Coxe M, Tisminetzky M, Lessard D, Gore JM, et al. Symptom presentation in patients hospitalized with acute heart failure. Clin Cardiol. 2010;33:E73–80.

    PubMed  Google Scholar 

  62. Kociol RD, Greiner MA, Hammill BG, Eapen ZJ, Fonarow GC, Klaskala W, et al. B-type natriuretic peptide level and postdischarge thrombotic events in older patients hospitalized with heart failure: insights from the Acute decompensated Heart Failure National Registry. Am Heart J. 2012;163:994–1001.

    PubMed  CAS  Google Scholar 

  63. Fitzgibbons TP, Hardy OT, Lessard D, Gore JM, Yarzebski J, Goldberg RJ. Body mass index, treatment practices, and mortality in patients with acute heart failure. Coron Artery Dis. 2009;20:536–43.

    PubMed  Google Scholar 

  64. Kinagasa Y, Kato M, Sugihara S, Hirai M, Kotani K, Ishida K, et al. A simple risk score to predict in-hospital death of elderly patients with acute decompensated heart failure- hypoalbuminemia as an additional prognostic factor. Circ J. 2009;73:2276–81.

    Google Scholar 

  65. Felker GM, Lee KL, Bull DA, et al. Diuretic strategies in patients with acute decompensated heart failure. New Engl J Med. 2011;364:797–805.

    PubMed  CAS  Google Scholar 

  66. Binanay C, Califf RM, Hasselblad V, et al. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA: J Am Med Assoc. 2005;294:1625–33.

    Google Scholar 

  67. Giamouzis G, Butler J, Starling RC, et al. Impact of dopamine infusion on renal function in hospitalized heart failure patients: results of the Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial. J Card Fail. 2010;16:922–30.

    PubMed  CAS  Google Scholar 

  68. Costanzo MR, Guglin ME, Saltzberg MT, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol. 2007;49:675–83.

    PubMed  CAS  Google Scholar 

  69. Bart BA, Goldsmith SR, Lee KL, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med. 2012;367:2296–304.

    PubMed  CAS  Google Scholar 

  70. Konstam MA, Gheorghiade M, Burnett Jr JC, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA: J Am Med Assoc. 2007;297:1319–31.

    CAS  Google Scholar 

  71. O’Connor CM, Starling RC, Hernandez AF, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365:32–43.

    PubMed  Google Scholar 

  72. Teerlink JR, Cotter G, Davison BA, et al. Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet. Nov 6 2012;Online first: doi:10.1016/S0140-6736(12)61855-8.

  73. Paterna S, Gaspare P, Fasullo S, Sarullo FM, DiPasquale P. Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? Clin Sci. 2008;114:221–30.

    PubMed  CAS  Google Scholar 

  74. Aliti GB, Rabelo ER, Clausell N, Rodhe LE, Biolo A, Beck-da-Silva L. Aggressive fluid and sodium restriction in acute decompensated heart failure. A randomized clinical trial. JAMA Intern Med (published online May 20, 2013).

  75. Austin J, Williams R, Ross L, Moseley L, Hutchison S. Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure. Eur J Heart Fail. 2005;7:411–7.

    PubMed  Google Scholar 

  76. Owen A, Croucher L. Effect of an exercise programme for elderly patients with heart failure. Eur J Heart Fail. 2000;2:65–70.

    PubMed  CAS  Google Scholar 

  77. Kitzman DW, Brubaker PH, Morgan TM, Stewart KP, Little WC. Exercise training in older patients with heart failure and preserved ejection fraction: a randomized controlled single-blind trial. Circ Heart Fail. 2010;3:659–67.

    PubMed  Google Scholar 

  78. Edelmann F, Gelbrich G, Dingen HD, et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure and preserved ejection fraction: results from the Ex-DHF( Exercise training in Diastolic Heart failure pilot study. J Am J Cardiol. 2011;58:1780–91.

    Google Scholar 

  79. O’Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301:1439–50.

    PubMed  Google Scholar 

  80. Rich MW, Beckham V, Wittenberg C, et al. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995;333:1190–5.

    PubMed  CAS  Google Scholar 

  81. Stewart S, Marley JE, Horowitz JD. Effects of a multidisciplinary, home-based intervention on unplanned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study. Lancet. 1999;354:1077–83.

    PubMed  CAS  Google Scholar 

  82. Takeda A, Taylor SJ, Taylor RS, et al. Clinical service organisation for heart failure. Cochrane Data-Base Syst Rev. 2012;9:CD002752.

    Google Scholar 

  83. • Masoudi FA, Havranek EP, Wolfe P, et al. Most hospitalized older persons do not meet the enrollment criteria for clinical trials in heart failure. Am Heart J. 2003;146(2):250–7. Study showing the limited generalizability of many heart failure trials to older patients with significant comorbid disease.

    PubMed  Google Scholar 

  84. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293–302.

    Google Scholar 

  85. Zile MR, Gaasch WH, Anand IS, et al. Mode of death in patients with heart failure and a preserved ejection fraction: results from the Irbesartan in Heart Failure with Preserved Ejection Fraction Study (I-Preserve) trial. Circulation. 2010;121(12):1393–405.

    PubMed  Google Scholar 

  86. Carson P, Anand I, O’Connor C, et al. Mode of death in advanced heart failure: the Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) trial. J Am Coll Cardiol. 2005;46(12):2329–34.

    PubMed  Google Scholar 

  87. Deedwania PC, Gottlieb S, Ghali JK, Waagstein F, Wikstrand JC, Group M-HS. Efficacy, safety and tolerability of beta-adrenergic blockade with metoprolol CR/XL in elderly patients with heart failure. Euro Heart J. 2004;25(15):1300–9.

    CAS  Google Scholar 

  88. The MERIT-HF Investigators. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999;353(9169):2001–7.

    Google Scholar 

  89. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709–17.

    PubMed  CAS  Google Scholar 

  90. The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336(8):525–33.

    Google Scholar 

  91. Gambassi G, Forman DE, Lapane KL, Mor V, Sgadari A, Lipsitz LA, et al. Management of heart failure among very old persons living in long-term care: has the voice of trials spread? The SAGE Study Group. Am Heart J. 2000;139(1 Pt 1):85–93.

    PubMed  CAS  Google Scholar 

  92. Hunt SA, Abraham WT, Chin MH, et al. 2009 focused update incorporated into the ACC/AHA 2005 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. 2009;119(14):e391–479.

    PubMed  Google Scholar 

  93. Ahmed A, Young JB, Love TE, Levesque R, Pitt B. A propensity-matched study of the effects of chronic diuretic therapy on mortality and hospitalization in older adults with heart failure. Int J Cardiol. 2008;125:246–53.

    PubMed  Google Scholar 

  94. Alper AB, Campbell RC, Anker SD, et al. A propensity-matched study of low serum potassium and mortality in older adults with chronic heart failure. Int J Cardiol. 2009;137(1):1–8.

    PubMed  Google Scholar 

  95. Ahmed A, Pitt B, Filippatos GS, et al. Treatment effect versus selection bias in systolic heart failure patients receiving higher target doses of ACE inhibitors: insights from Studies of Left Ventricular Dysfunction (SOLVD) treatment trial. Euro Heart J. doi:10.1093/eurheartj/ehs283. 2012;33(Suppl 1 (ESC Congress 2012, Munchen, Germany, 25–29 August 2012)):804.

  96. Packer M, Bristow MR, Cohn JN, et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med. 1996;334:1349–55.

    PubMed  CAS  Google Scholar 

  97. Packer M, Coats AJ, Fowler MB, et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med. 2001;344(22):1651–8.

    PubMed  CAS  Google Scholar 

  98. The CIBIS-II Investigators. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999;353(9146):9–13.

    Google Scholar 

  99. Poole-Wilson PA, Swedberg K, Cleland JG, et al. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet. 2003;362:7–13.

    PubMed  CAS  Google Scholar 

  100. Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348(14):1309–21.

    PubMed  CAS  Google Scholar 

  101. Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11–21.

    PubMed  CAS  Google Scholar 

  102. Hernandez AF, Mi X, Hammill BG, et al. Associations between aldosterone antagonist therapy and risks of mortality and readmission among patients with heart failure and reduced ejection fraction. JAMA. 2012;308(20):2097–107.

    PubMed  CAS  Google Scholar 

  103. Taylor AL, Ziesche S, Yancy C, et al. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med. 2004;351(20):2049–57.

    PubMed  CAS  Google Scholar 

  104. Ahmed A, Pitt B, Rahimtoola SH, et al. Effects of digoxin at low serum concentrations on mortality and hospitalization in heart failure: a propensity-matched study of the DIG trial. Int J Cardiol. 2008;123(2):138–46.

    PubMed  Google Scholar 

  105. Ahmed A, Rich MW, Love TE, et al. Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J. 2006;27(2):178–86.

    PubMed  CAS  Google Scholar 

  106. Massie B, Bourassa M, DiBianco R, et al. Long-term oral administration of amrinone for congestive heart failure: lack of efficacy in a multicenter controlled trial. Circulation. 1985;71(5):963–71.

    PubMed  CAS  Google Scholar 

  107. Packer M, Carver JR, Rodeheffer RJ, et al. Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE Study Research Group. N Engl J Med. 1991;325(21):1468–75.

    PubMed  CAS  Google Scholar 

  108. Slawsky MT, Colucci WS, Gottlieb SS, et al. Acute hemodynamic and clinical effects of levosimendan in patients with severe heart failure. Study Investigators. Circulation. 2000;102(18):2222–7.

    PubMed  CAS  Google Scholar 

  109. Swedberg K, Komajda M, Bohm M, et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet. 2010;376(9744):875–85.

    PubMed  CAS  Google Scholar 

  110. Shamim W, Francis DP, Yousufuddin M, et al. Intraventricular conduction delay: a prognostic marker in chronic heart failure. Int J Cardiol. 1999;70(2):171–8.

    PubMed  CAS  Google Scholar 

  111. Abraham WT, Fisher WG, Smith AL, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346(24):1845–53.

    PubMed  Google Scholar 

  112. Bristow MR, Saxon LA, Boehmer J, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140–50.

    PubMed  CAS  Google Scholar 

  113. Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539–49.

    PubMed  CAS  Google Scholar 

  114. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877–83.

    PubMed  Google Scholar 

  115. Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352(3):225–37.

    PubMed  CAS  Google Scholar 

  116. Mark DB, Anstrom KJ, Sun JL, et al. Quality of life with defibrillator therapy or amiodarone in heart failure. N Engl J Med. 2008;359(10):999–1008.

    PubMed  CAS  Google Scholar 

  117. Mishkin JD, Saxonhouse SJ, Woo GW, et al. Appropriate evaluation and treatment of heart failure patients after implantable cardioverter-defibrillator discharge: time to go beyond the initial shock. J Am Coll Cardiol. 2009;54(22):1993–2000.

    PubMed  Google Scholar 

  118. Makkar RR, Fontana GP, Jilaihawi H, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2012;366(18):1696–704.

    PubMed  CAS  Google Scholar 

  119. Velazquez EJ, Lee KL, Deja MA, et al. Coronary-artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med. 2011;364(17):1607–16.

    PubMed  CAS  Google Scholar 

  120. Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435–43.

    PubMed  CAS  Google Scholar 

  121. Lietz K, Long JW, Kfoury AG, et al. Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection. Circulation. 2007;116(5):497–505.

    PubMed  Google Scholar 

  122. Mujib M, Patel K, Fonarow GC, et al. Angiotensin-converting enzyme inhibitor use and outcomes in older patients with heart failure and preserved ejection fraction Am J Med. 2013 (revision under review).

  123. Cleland JG, Tendera M, Adamus J, et al. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J. 2006;27(19):2338–45.

    PubMed  CAS  Google Scholar 

  124. Patel K, Fonarow GC, Kitzman DW, et al. Angiotensin receptor blockers and outcomes in real-world older patients with heart failure and preserved ejection fraction: a propensity-matched inception cohort clinical effectiveness study. Eur J Heart Fail. Jul 3 2012.

  125. Hernandez AF, Hammill BG, O’Connor CM, Schulman KA, Curtis LH, Fonarow GC. Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry. J Am Coll Cardiol. 2009;53(2):184–92.

    PubMed  CAS  Google Scholar 

  126. Flather MD, Shibata MC, Coats AJ, et al. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J. 2005;26(3):215–25.

    PubMed  CAS  Google Scholar 

  127. Patel K, Fonarow GC, Kitzman DW, et al. Aldosterone antagonists and outcomes in real-world older patients with heart failure and preserved ejection fraction. JACC Heart Failure. 2013.

  128. • Patel K, Fonarow GC, Kitzman DW, et al. Aldosterone antagonists and outcomes in real-world older patients with heart failure and preserved ejection fraction. JACC Heart Fail. 2013;1(1):40–7. Paper highlighting the limited generalizability of evidence-based aldosterone blockers for typical, very old HF patients.

    PubMed  Google Scholar 

  129. Desai AS, Lewis EF, Li R, et al. Rationale and design of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial: a randomized, controlled study of spironolactone in patients with symptomatic heart failure and preserved ejection fraction. Am Heart J. 2011;162:966–72.

    PubMed  CAS  Google Scholar 

  130. Ahmed A, Rich MW, Fleg JL, et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial. Circulation. 2006;114:397–403.

    PubMed  CAS  Google Scholar 

  131. Ahmed A, Patel K, Aban IB, et al. Use of non-amlodipine calcium channel blockers is not associated with outcomes in older patients with heart failure and preserved ejection fraction. J Am Coll Cardiol. 2013;61(10_S):. doi:10.1016/S0735-1097(13)60762-7.

  132. Gómez-Batiste X, Martínez-Muñoz M, Blay C, et al. Identifying patients with chronic conditions in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia. BMJ Support Palliat Care. 2012. doi:10.1136/bmjspcare-2012-000211.

    Google Scholar 

Download references

Disclaimer

This manuscript reflects the views of the authors and does not necessarily reflect those of the National Institutes of Health, the Department of Health and Human Services, or the Department of Veteran Affairs.

Compliance with Ethics Guidelines

Conflict of Interest

Daniel E. Forman, Ali Ahmed, and Jerome L. Fleg declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniel E. Forman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Forman, D.E., Ahmed, A. & Fleg, J.L. Heart Failure in Very Old Adults. Curr Heart Fail Rep 10, 387–400 (2013). https://doi.org/10.1007/s11897-013-0163-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-013-0163-7

Keywords

Navigation