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


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.


Chronic heart failure Therapy Comorbidity Adherence 



Chronic heart failure


Chronic heart failure with preserved ejection fraction


Chronic heart failure with reduced ejection fraction


American college of cardiology


America heart association


Euro heart failure survey


Angiotensin-converting enzyme inhibitors


Angiotensin receptor blockers (ARBs)


Coronary artery disease


National health and nutrition examination survey


Studies of left ventricular dysfunction


Body mass index


New York heart association


European society of cardiology


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


Perindopril in elderly people with chronic heart failure


Irbesartan in heart failure with preserved ejection fraction


Evaluation of Losartan in the elderly II


Valsartan heart failure trial


Cardiac insufficiency bisoprolol study II


Carvedilol prospective randomized cumulative survival


Metoprolol CR/XL randomized intervention trial in heart failure


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


Digitalis investigation group


Randomized aldactone evaluation study


Eplerenone post-AMI heart failure efficacy and survival stud


Systolic heart failure treatment with the if inhibitor ivabradine trial


Veterans administration cooperative vasodilator—heart failure II


Cardiac resynchronization therapy—pacemaker


Cardiac resynchronization therapy—defibrillator


Implantable cardioverter defibrillator


Heart failure—controlled trial investigating outcomes of exercise training


Ventricular assist device


Coronary artery bypass grafting


Sarcoplasmic reticulum


Sarcoplasmic reticulum Ca(2+)-ATPase


Adeno-associated virus


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


β-adrenergic receptor kinase-1


G protein-coupled receptor kinase 2


Pain assessment, incidence, and nature in heart failure


Nonsteroidal anti-inflammatory drugs


Weight monitoring in HeARt failure


Remote patients monitoring


Conflict of Interest

Drs. Pasquale Abete, Gianluca Testa, David Della-Morte, Gaetano Gargiulo, Gianluigi Galizia, Domenico de Santis, Antonio Magliocca, Claudia Basile, and Francesco Cacciatore have no conflicts of interest or financial ties to disclose.


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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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