Therapy in Practice

Drugs & Aging

, Volume 30, Issue 10, pp 765-782

First online:

Medication Management of Chronic Heart Failure in Older Adults

  • Kannayiram AlagiakrishnanAffiliated withDivision of Geriatric Medicine, Department of Medicine, University of Alberta Email author 
  • , Maciej BanachAffiliated withDepartment of Hypertension, Medical University of Lodz
  • , Linda G. JonesAffiliated withSection of Geriatrics, Veterans Affairs Medical CenterDivision of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
  • , Ali AhmedAffiliated withSection of Geriatrics, Veterans Affairs Medical CenterDivision of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
  • , Wilbert S. AronowAffiliated withDivision of Cardiology, Geriatrics and Pulmonary/Critical Care, Department of Medicine, New York Medical College

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Abstract

Heart failure (HF) is a common problem in older adults. Individuals aged 65 years or older are at a higher risk for developing HF, especially diastolic HF or HF with preserved ejection fraction (HFpEF). HF can be seen in up to 20 % of adults aged 85 years or older. In contrast to middle-aged (40–64 years) HF patients, multiple cardiac, non-cardiac and geriatric syndrome co-morbidities are seen in elderly HF patients. Additionally, age-related changes in pharmacokinetics and pharmacodynamics influence medication therapy. Hence, the management of older patients with HF is challenging and treatment should be modified in the light of the above-mentioned conditions. This article discusses the current evidence for medication management in both systolic HF or HF with reduced ejection fraction (HFrEF) and HFpEF, noting, however, the limited data for HFpEF and HFrEF in those 80 years of age or older. The objective of this article is to discuss evidence-based and outcomes-driven pharmacologic management strategies for chronic HF in the older adults for whom functional and other patient-centered outcomes might be more than or as important as clinical outcomes. Optimal management would be expected to help to reduce illness burden, reduce mortality and hospitalizations, and improve function and quality of life.