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

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.

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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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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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Abete, P., Testa, G., Della-Morte, D. et al. Treatment for chronic heart failure in the elderly: current practice and problems. Heart Fail Rev 18, 529–551 (2013). https://doi.org/10.1007/s10741-012-9363-6

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Keywords

  • Chronic heart failure
  • Therapy
  • Comorbidity
  • Adherence