Les cahiers de l'année gérontologique

, Volume 4, Issue 3, pp 301–309 | Cite as

Le traitement du patient âgé insuffisant cardiaque : synthèse des données disponibles en 2012

  • E. Ferrat
  • M. Medioni
  • J. Le Breton
  • L. Compagnon
  • J. Cittée
  • S. Bercier
  • V. Renard
  • C. Attali
Article / Article
  • 74 Downloads

Résumé

L’insuffisance cardiaque (IC) est une pathologie chronique fréquente chez le sujet âgé dont les coûts de prise en charge et la morbimortalité restent élevés. La prise en charge des sujets âgés atteints d’IC relève le plus souvent des médecins généralistes (MG). Cependant, il existe une sous-utilisation des thérapeutiques recommandées notamment des inhibiteurs de l’enzyme de conversion (IEC), des bêtabloquants (BB) et antialdostérones chez les patients âgés atteints d’IC, par ailleurs souvent polypathologiques. La plupart des essais cliniques réalisés dans le cadre de l’IC ont inclut des individus dont l’âge n’excédait pas 80 ans. Pour autant, les objectifs généraux de la prise en charge du patient IC définis par la Société européenne de cardiologie restent applicables au sujet âgé: amélioration de la qualité de vie, réduction de la mortalité, du nombre et de la durée des hospitalisations, ralentissement de la progression de la maladie. Chez le sujet fragile ou en fin de vie, le traitement symptomatique reste prioritaire. Les IEC et BB ont montré une diminution de la morbimortalité dans l’IC systolique quel que soit l’âge. Des résultats similaires ont été observés dans des études observationnelles menées chez le sujet âgé. Pour l’insuffisance cardiaque à fraction d’éjection préservée, les données actuelles ne permettent pas de conclure à une diminution de la mortalité mais ils sembleraient que les IEC/ARA2 réduisent les hospitalisations et améliorent les symptômes. La prise en charge multidisciplinaire incluant l’éducation thérapeutique a montré son efficacité chez le sujet âgé en réduisant les hospitalisations et les coûts liés à la prise en charge. L’éducation thérapeutique est un élément important de la prise en charge et devra être adaptée aux possibilités du patient. En cas de troubles cognitifs, celle-ci devrait cibler l’entourage proche. Les principaux éléments que doit comporter l’éducation thérapeutique sont la reconnaissance des signes d’alerte, l’observance médicamenteuse, la surveillance du poids et le respect des règles hygiénodiététiques plus souples chez la personne âgée.

Mots clés

Personne âgée Insuffisance cardiaque Revue de la littérature Essai contrôlé randomisé Éducation thérapeutique 

Management of elderly with heart failure: review of available data in 2012

Abstract

Heart failure (HF) is a common chronic disease among elderly and whose costs of care, morbidity and mortality remain high. Management of elderly patients with HF is mostly realized by general practitioners (GPs). However, we observed an underuse of recommended drugs therapy including angiotensin converting enzyme (ACE-I), Betablockers (BB) and aldosterone antagonists in elderly patients with HF who usually have several diseases. Most clinical trials conducted on HF, have included individuals whose age did not exceed 80 years old. However, the main objectives concerning management of patients suffering from HF defined by the European Society of Cardiology (ESC) remain applicable to the elderly: improvement of quality of life, reduction of mortality as well as the number and duration of hospitalizations and finally reduction in disease progression. In frail or end-of-life patients, symptomatic treatment remains a priority. ACE-I and BB have showed a decrease in morbidity and mortality among HF patients regardless of their age. Similar results were observed in observational studies conducted in elderly patients. For heart failure with preserved ejection fraction, current data don’t support a significant reduction in mortality but it seems that ACE-I/ARBs reduce hospitalizations and improve symptoms. The multidisciplinary approach including therapeutic education showed its efficiency among the elderly by reducing hospitalizations and costs of care. Therapeutic education is an important component of HF management and should be adapted according to the patient’s capabilities. In case of cognitive impairment, therapeutic education should focus on the close acquaintances. The main elements that should include therapeutic education are recognition of warning signs, drug compliance, weight monitoring and compliance with lifestyle and dietary measures more flexible in the elderly.

Keywords

Elderly Heart failure Review Randomised controlled trial Therapeutic education 

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Copyright information

© Springer-Verlag France 2012

Authors and Affiliations

  • E. Ferrat
    • 1
    • 2
  • M. Medioni
    • 1
    • 2
  • J. Le Breton
    • 1
    • 2
  • L. Compagnon
    • 1
    • 2
  • J. Cittée
    • 1
    • 2
  • S. Bercier
    • 1
    • 2
  • V. Renard
    • 1
    • 2
  • C. Attali
    • 1
    • 2
  1. 1.Département universitaire d’enseignement et de recherche en médecine généraleUPECCréteil cedexFrance
  2. 2.Université Paris-Est (UPEC), faculté de médecinelaboratoire d’Investigation clinique (LIC EA 4393)CréteilFrance

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