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Heart Failure Reviews

, Volume 15, Issue 5, pp 401–405 | Cite as

Aging and heart failure: changing demographics and implications for therapy in the elderly

  • Bodh I. JugduttEmail author
Article

Abstract

The elderly population (age ≥65) is increasing and with it morbidity, hospitalizations, costs and mortality due to heart failure (HF). HF is a progressive disorder that is superimposed on an on-going aging process. The two broad categories of HF, HF with left ventricular (LV) systolic dysfunction or low ejection fraction (HF/low-EF) and HF with preserved ejection fraction (HF/PEF) are equally prevalent in the elderly. Trials of therapy for HF/low-EF in primarily non-elderly patients showed mortality benefit in elderly patients. In contrast, trials for HF/PEF have not shown mortality benefit in elderly or non-elderly patients. HF pharmacotherapy in the elderly is challenging and needs to be individualized and consider several aging-related changes. More research into the biology of aging and more clinical trials in elderly patients are needed to improve morbidity and mortality in elderly HF patients.

Keywords

Aging Heart failure Elderly Demographics Therapy 

Notes

Acknowledgments

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

References

  1. 1.
    Kannel WB, Belanger AJ (1991) Epidemiology of heart failure. Am Heart J 121:951–957CrossRefPubMedGoogle Scholar
  2. 2.
    O’Connell JB (2000) The economic burden of heart failure. Clin Cardiol 23(Suppl III):6–103Google Scholar
  3. 3.
    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–e170CrossRefGoogle Scholar
  4. 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–e235CrossRefPubMedGoogle Scholar
  5. 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 119:1977–2016CrossRefPubMedGoogle Scholar
  6. 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 10:933–989CrossRefPubMedGoogle Scholar
  7. 7.
    Jugdutt BI (2008) Aging and remodeling during healing of the wounded heart: current therapies and novel drug targets. Current Drug Targets 9:325–344CrossRefPubMedGoogle Scholar
  8. 8.
    World Health Organization (WHO) Definition of an older or elderly person. http://www.who.int/healthinfo/survey/ageingdefnolder/en/print.html. Accessed 30 Dec 2009
  9. 9.
    Roebuck J (1979) When does old age begin?: the evolution of the english definition. J Soc Hist 12:416–428Google Scholar
  10. 10.
    Gorman M (1999) Development and the rights of older people. In: Randel J et al (eds) The ageing and development report: poverty, independence and the world’s older people. Earthscan Publications Ltd., London, pp 3–21Google Scholar
  11. 11.
    Glascock AP, Fenman SL (1980) A holocultural analysis of old age. Comp Soc Res 3:311–332Google Scholar
  12. 12.
    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 115:2570–2589CrossRefPubMedGoogle Scholar
  13. 13.
    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 19:430–435PubMedGoogle Scholar
  14. 14.
    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 96:3294–3299PubMedGoogle Scholar
  15. 15.
    McMurray JJ, Stewart S (2000) Epidemiology, aetiology, and prognosis of heart failure. Heart 83:596–602CrossRefPubMedGoogle Scholar
  16. 16.
    Mendez GF, Cowie MR (2001) The epidemiological features of heart failure in developing countries: a review of the literature. Int J Cardiol 80:213–219CrossRefPubMedGoogle Scholar
  17. 17.
    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 11:6–11CrossRefPubMedGoogle Scholar
  18. 18.
    McDonald K (2008) Diastolic heart failure in the elderly: underlying mechanisms and clinical relevance. Int J Cardiol 125:197–202CrossRefPubMedGoogle Scholar
  19. 19.
    Tehrani F, Phan A, Chien CV, Morrissey RP, Rafique AM, Schwarz ER (2009) Value of medical therapy in patients >80 years of age with heart failure and preserved ejection fraction. Am J Cardiol 103:829–833CrossRefPubMedGoogle Scholar
  20. 20.
    Orn S, Dickstein K (2002) How do heart failure patients dies? Eur Heart Fail Suppl 4:D59–D65CrossRefGoogle Scholar
  21. 21.
    Mozaffarian D, Anker SD, Anand I et al (2007) Prediction of mode of death in heart failure: the Seattle heart failure model. Circulation 116:392–398CrossRefPubMedGoogle Scholar
  22. 22.
    Cheitlin MD, Gerstenblith G, Hazzard WR et al (2001) Database conference January 27–30, 2000, Washington D.C.—Do existing databases answer clinical questions about geriatric cardiovascular disease and stroke? Am J Geriatr Cardiol 10:207–223CrossRefPubMedGoogle Scholar
  23. 23.
    Komajda M, Hanon O, Hochadel M et al (2007) Management of octogenarians hospitalized for heart failure in Euro heart failure survey I. Eur Heart J 28:1310–1318CrossRefPubMedGoogle Scholar
  24. 24.
    Mahjoub H, Rusinaru D, Soulière V, Durier C, Peltier M, Tribouilloy C (2008) Long-term survival in patients older than 80 years hospitalised for heart failure. A 5-year prospective study. Eur J Heart Fail 10:78–84CrossRefPubMedGoogle Scholar
  25. 25.
    Komajda M, Hanon O, Hochadel M et al (2009) Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro heart failure survey II. Eur Heart J 30:478–486CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Cardiology, Department of Medicine and Cardiovascular Research Group, Faculty of Medicine, 2C2 Walter MacKenzie Health Sciences CentreUniversity of AlbertaEdmontonCanada

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