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Drugs & Aging

, Volume 36, Issue 2, pp 137–146 | Cite as

Contemporary Management of Heart Failure in the Elderly

  • Joanna Osmanska
  • Pardeep S. JhundEmail author
Review Article

Abstract

The foundation of the treatment of heart failure with reduced ejection fraction is a number of pharmacotherapies shown to reduce morbidity and mortality in large randomised multinational clinical trials. These include angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and more recently, a combined angiotensin receptor blocker neprilysin inhibitor, sacubitril/valsartan. In select cases, digoxin, ivabradine and hydralazine with isosorbide dinitrate have a role to play in the treatment of heart failure with reduced ejection fraction. On this foundation, other more advanced treatments such as implantable cardioverter defibrillators and cardiac resynchronisation therapy are recommended in guidelines for the treatment of heart failure with reduced ejection fraction (i.e. an ejection fraction of ≤ 40%) and for a select few there remains the option of mechanical circulatory support and cardiac transplantation. The efficacy of pharmacotherapy does not vary by age and each of these therapies should be considered in all patients, irrespective of age. Other factors such as co-morbidities like renal dysfunction may limit the use of some of these drugs in the elderly. Decision making with regard to device therapy is more complex; the likelihood of competing non-cardiovascular causes of death and life expectancy need to be considered. Despite multiple treatment options for heart failure with reduced ejection fraction, the options for heart failure with preserved ejection fraction are limited. In the absence of robust outcomes data from a large randomised trial, a mineralocorticoid receptor antagonist is a reasonable therapy to reduce the risk of hospitalisation for heart failure in patients with heart failure with preserved ejection fraction.

Notes

Compliance with Ethical Standards

Funding

No sources of funding were used in the preparation of this review article.

Conflict of Interest

Joanna Osmanska has no conflicts of interest that are directly relevant to the contents of this article. Pardeep S. Jhund has received speakers’ fees from Novartis, advisory board fees from Novartis, Vifor Pharma, Boehringer Ingelheim and Amgen, and research grants from Boehringer Ingelheim.

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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK

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