Heart Failure Reviews

, Volume 18, Issue 4, pp 529–551 | Cite as

Treatment for chronic heart failure in the elderly: current practice and problems

  • Pasquale Abete
  • Gianluca Testa
  • David Della-Morte
  • Gaetano Gargiulo
  • Gianluigi Galizia
  • Domenico de Santis
  • Antonio Magliocca
  • Claudia Basile
  • Francesco Cacciatore
Article

Abstract

Treatment for chronic heart failure (CHF) is strongly focused on evidence-based medicine. However, large trials are often far away from the “real world” of geriatric patients and their messages are poorly transferable to the clinical management of CHF elderly patients. Precipitating factors and especially non-cardiac comorbidity may decompensate CHF in the elderly. More importantly, drugs of first choice, such as angiotensin-converting enzyme inhibitors and β-blockers, are still underused and effective drugs on diastolic dysfunction are not available. Poor adherence to therapy, especially for cognitive and depression disorders, worsens the management. Electrical therapy is indicated, but attention to the older age groups with reduced life expectancy has to be paid. Physical exercise, stem cells, gene delivery, and new devices are encouraging, but definitive results are still not available. Palliative care plays a key role to the end-stage of the disease. Follow-up of CHF elderly patient is very important but tele-medicine is the future. Finally, self-care management, caregiver training, and multidimensional team represent the critical point of the treatment for CHF elderly patients.

Keywords

Chronic heart failure Therapy Comorbidity Adherence 

Abbreviations

CHF

Chronic heart failure

CHF-PEF

Chronic heart failure with preserved ejection fraction

CHF-REF

Chronic heart failure with reduced ejection fraction

ACC

American college of cardiology

AHA

America heart association

EHFS

Euro heart failure survey

ACE-I

Angiotensin-converting enzyme inhibitors

ARBs

Angiotensin receptor blockers (ARBs)

CAD

Coronary artery disease

NHANES

National health and nutrition examination survey

SOLVD

Studies of left ventricular dysfunction

BMI

Body mass index

NYHA

New York heart association

ESC

European society of cardiology

CHARM

Candesartan in heart failure: Assessment of reduction in mortality and morbidity

PEP-CHF

Perindopril in elderly people with chronic heart failure

I-PRESERVE

Irbesartan in heart failure with preserved ejection fraction

ELITE II

Evaluation of Losartan in the elderly II

Val-HeFT

Valsartan heart failure trial

CIBIS II

Cardiac insufficiency bisoprolol study II

COPERNICUS

Carvedilol prospective randomized cumulative survival

MERIT-HF

Metoprolol CR/XL randomized intervention trial in heart failure

SENIORS

Study of the effects of nebivolol intervention on outcomes and rehospitalization in seniors with heart failure

DIG

Digitalis investigation group

RALES

Randomized aldactone evaluation study

EPHESUS

Eplerenone post-AMI heart failure efficacy and survival stud

SHIFT

Systolic heart failure treatment with the if inhibitor ivabradine trial

V-HeFT II

Veterans administration cooperative vasodilator—heart failure II

CRT-P

Cardiac resynchronization therapy—pacemaker

CRT-D

Cardiac resynchronization therapy—defibrillator

ICD

Implantable cardioverter defibrillator

HF-ACTION

Heart failure—controlled trial investigating outcomes of exercise training

VAD

Ventricular assist device

CABG

Coronary artery bypass grafting

SR

Sarcoplasmic reticulum

SERCA

Sarcoplasmic reticulum Ca(2+)-ATPase

AAV

Adeno-associated virus

CUPID

Calcium upregulation by percutaneous administration of gene therapy in cardiac disease (CUPID)

βARK1

β-adrenergic receptor kinase-1

GRK2

G protein-coupled receptor kinase 2

PAIN-HF

Pain assessment, incidence, and nature in heart failure

NSAID

Nonsteroidal anti-inflammatory drugs

WHARF

Weight monitoring in HeARt failure

RPM

Remote patients monitoring

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Pasquale Abete
    • 1
  • Gianluca Testa
    • 1
    • 2
  • David Della-Morte
    • 3
  • Gaetano Gargiulo
    • 1
  • Gianluigi Galizia
    • 5
  • Domenico de Santis
    • 1
  • Antonio Magliocca
    • 1
  • Claudia Basile
    • 1
  • Francesco Cacciatore
    • 1
    • 4
  1. 1.Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Cattedra di GeriatriaUniversità degli Studi di Napoli “Federico II”NaplesItaly
  2. 2.Dipartimento di Medicina e Scienze della SaluteUniversità del MoliseCampobassoItaly
  3. 3.Department of Advanced Biotechnologies and BioimagingIRCCSSan Raffaele, RomeItaly
  4. 4.Istituto Scientifico di Campoli/Telese, Fondazione Salvatore MaugeriIRCCSBeneventoItaly
  5. 5.Istituto Scientifico di Veruno, Fondazione Salvatore MaugeriIRCCSVerunoItaly

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