Skip to main content
SpringerLink
Log in

Medication Management of Chronic Heart Failure in Older Adults

  • Therapy in Practice
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Heart failure (HF) is a common problem in older adults. Individuals aged 65 years or older are at a higher risk for developing HF, especially diastolic HF or HF with preserved ejection fraction (HFpEF). HF can be seen in up to 20 % of adults aged 85 years or older. In contrast to middle-aged (40–64 years) HF patients, multiple cardiac, non-cardiac and geriatric syndrome co-morbidities are seen in elderly HF patients. Additionally, age-related changes in pharmacokinetics and pharmacodynamics influence medication therapy. Hence, the management of older patients with HF is challenging and treatment should be modified in the light of the above-mentioned conditions. This article discusses the current evidence for medication management in both systolic HF or HF with reduced ejection fraction (HFrEF) and HFpEF, noting, however, the limited data for HFpEF and HFrEF in those 80 years of age or older. The objective of this article is to discuss evidence-based and outcomes-driven pharmacologic management strategies for chronic HF in the older adults for whom functional and other patient-centered outcomes might be more than or as important as clinical outcomes. Optimal management would be expected to help to reduce illness burden, reduce mortality and hospitalizations, and improve function and quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lloyd-Jones D, Adams RJ, Brown T, et al. Heart disease and stroke statistics – 2010 update: a report from the American Heart Association. Circulation. 2010;121:e46–215.

    Article  PubMed  Google Scholar 

  2. WHO definition of an older or elderly person. http://www.who.int/healthinfo/survey/agingdefnolder/en/index.html. Accessed 20 Jan 2013.

  3. Lloyd-Jones D, Adams R, Carnethon M, for the American Heart Association Statistics Committee and Stroke Stastistics Subcommitee, et al. Heart disease and stroke statistics – 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:e21–181.

    Article  PubMed  Google Scholar 

  4. McMurray JJV, Stewart S. The burden of heart failure. Eur Heart J Suppl. 2002;4:D50–8.

    Article  Google Scholar 

  5. Jessup M, Brozena S. Heart failure. N Engl J Med. 2003;348(2007–1):8.

    Google Scholar 

  6. Mahjuub H, Rusimaru D, Souliere V, Durier C, Peltier M, Tribouilloy C. Long- term survival in patients older than 80 years hospitalized for heart failure: a 5-year prospective study. Eur J Heart Fail. 2008;10:78–84.

    Article  Google Scholar 

  7. Incidence and Prevalence: 2006 chart book on cardiovascular and lung diseases. Bethesda, Maryland, USA: National Institute of Health, National Heart, Lung and Blood Institute, p. 73.

  8. Komajda M, Hanon O, Hochadel M, et al. Management of octogenarians hospitalized for heart failure in Euro heart failure survey I. Eur Heart J. 2007;28:1310–8.

    Article  PubMed  Google Scholar 

  9. Lien CT, Gillespie ND, Struthers AD, Mcmurdo ME. Heart failure in frail elderly patients: diagnostic difficulties, co- morbidities, polypharmacy and treatment dilemmas. Eur J Heart Fail. 2002;4:91–8.

    Article  PubMed  Google Scholar 

  10. Cherubini A, Oristrell J, Pla X, et al. The persistent exclusion of older patients from ongoing clinical trials regarding heart failure. Arch Intern Med. 2011;171(6):550–6.

    Article  PubMed  Google Scholar 

  11. Phan TT, Shivu GN, Abozguia K, et al. The pathophysiology of heart failure with preserved ejection fraction: from molecular mechanisms to exercise haemodynamics. Int J Cardiol. 2012;158:337–43.

    Article  PubMed  Google Scholar 

  12. Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults. A report of the American College of Cardiology/American Heart Association task force on practice guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;110:e391–479.

    Google Scholar 

  13. Brater DC. Diuretic therapy. N Engl J Med. 1998;339:387–95.

    Article  PubMed  CAS  Google Scholar 

  14. Aronow WS. Heart Failure update: treatment of heart failure with a normal left ventricular ejection fraction in the elderly. Geriatrics. 2006;61(8):16–20.

    PubMed  Google Scholar 

  15. Tsutsui T, Tsutamoto T, Maeda K, Kinoshita M. Comparison of neurohumoral effects of short-acting and long-acting loop diuretics in patients with chronic congestive heart failure. J Cardiovasc Pharmacol 2001;38:(Suppl.1):581–85.

    Google Scholar 

  16. Hisatake S, Nanjo S, Fujimoto S, et al. Comparative analysis of the therapeutic effects of long-acting and short-acting loop diuretics in the treatment of chronic heart failure using 125 I-metaiodobenzylguanidine scintigraphy. Eur J Heart Fail. 2011;13:892–8.

    Article  PubMed  CAS  Google Scholar 

  17. Ahmed A, Young JB, Love TE, et al. A propensity matched study of the effects of chronic diuretic therapy on mortality and hospitalization in older adults with heart failure. Int J Cardiol. 2008;125:246–53.

    Article  PubMed  Google Scholar 

  18. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709–17.

    Article  PubMed  CAS  Google Scholar 

  19. Donaski M, Tian X, Haigney M, Pitt B. Diuretic use, progressive heart failure and death in patients in the DIG study. J Card Fail. 2006;12:327–32.

    Article  CAS  Google Scholar 

  20. Masuyama T, Tsujino T, Origasa H, et al. Superiority of long-acting to short-acting loop diuretics in the treatment of congestive heart failure: the J-Melodic study. Circ J. 2012;76:833–42.

    Article  PubMed  CAS  Google Scholar 

  21. Faris RF, Flather M, Purcell H, et al. Diuretics for heart failure. Cochrane Database Syst Rev 2012;15(2):2; CD003638. doi:10.1002/14651858:CD003838:pub.3.

  22. Jentzer JC, Dewald TA, Hernandez AF. Combination of loop-diuretics with thiazide-type diuretics in heart failure. J Am Coll Cardiol. 2010;56:1527–34.

    Article  PubMed  CAS  Google Scholar 

  23. Sica DA. Metalazone and its role in edema management. Congest Heart Failure. 2007;9:100–5.

    Article  Google Scholar 

  24. Rosenberg J, Gustafsson F, Galatius S, Hildebrant PR. Combination therapy with metalazone and loop diuretics in outpatients with refractory heart failure: an observational study and review of the literature. Cardiovasc Drugs Ther. 2005;19:301–6.

    Article  PubMed  CAS  Google Scholar 

  25. Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364:11–21.

    Article  PubMed  CAS  Google Scholar 

  26. Ezekowitz JA, Mc Allister FA. Aldosterone blockade and left ventricular dysfunction: a systematic review of randomized clinical trials. Eur Heart J. 2009;30:469–77.

    Article  PubMed  CAS  Google Scholar 

  27. Zannad F, Stoug WG, Rossignol P, et al. Mineralocorticoid receptor antagonists for heart failure with reduced ejection fraction: intergrating evidence into clinical practice. Eur Heart J. 2012;33:2782–95.

    Article  PubMed  CAS  Google Scholar 

  28. Yamaji M, Tsutamato T, Kawahara C, et al. Effect of epleronone versus spironolactone on cortisol and HbA1c levels in patients with chronic heart failure. Am Heart J. 2010;160:915–21.

    Article  PubMed  CAS  Google Scholar 

  29. Roongsritong C, Sutthiwan P, Bradley J, et al. Sprinolactone improves diastolic function in the elderly. Clin Cardiol. 2005;28:484–7.

    Article  PubMed  Google Scholar 

  30. Alagiakrishnan K, Banach M, Jones LG, et al. Update on diastolic heart failure with preserved ejection fraction in the older adults. Ann Med. 2013;45:37–50.

    Article  PubMed  CAS  Google Scholar 

  31. Edelmann F, Wachter R, Schmidt AG, et al. Effect of spironolactone on diastolic function and exercise capacity in patients with preserved ejection fraction (The Aldo-DHF randomized controlled trial). JAMA. 2013;309(8):781–91.

    Article  PubMed  CAS  Google Scholar 

  32. Bielecka-Dabrowa A, Mikhailidis DP, Jones L, Rysz J, Aronow WS, Banach M. The meaning of hypokalemia in heart failure. Int J Cardiol. 2012;158(1):12–7.

    Article  PubMed  Google Scholar 

  33. Bielecka-Dabrowa A, Rysz J, Mikhailidis DP, Banach M. What is the risk of hyperkalaemia in heart failure? Expert Opin Pharmacother. 2011;12(15):2329–38.

    Article  PubMed  CAS  Google Scholar 

  34. Cooper HA, Dries DL, Davis CE, et al. Diuretics and risk of arrythmic death in patients with left ventricular dysfunction. Circulation. 1999;100:1311–5.

    Article  PubMed  CAS  Google Scholar 

  35. Bowling CB, Pitt B, Ahmed MI, et al. Hypokalemia and outcomes in patients with chronic heart failure and chronic kidney disease: findings from propensity-matched studies. Circ Heart Fail. 2010;3(2):253–60.

    Article  PubMed  Google Scholar 

  36. Cruz CS, Cruz DA, Marcilio DE, Souza CA. Hyperkalemia in congestive heart failure patients using ACE inhibitors and spirinolactone. Nephrol Dial Transpl. 2003;18:1814–9.

    Article  CAS  Google Scholar 

  37. Pitt B, Bakris G, Ruilope LM, et al. On behalf of the EPHESUS investigators. Serum potassium and clinical outcomes in the Eplerenone Post-acute myocardial infarction Heart failure Efficacy and Survival Study (EPHESUS). Circulation. 2008;118:1643–50.

    Article  PubMed  CAS  Google Scholar 

  38. Muzzarelli S, Maeder MT, Toggweiler S, et al. Frequency and predictors of hyperkalemia in patients >60 years of age with heart failure undergoing intense medical therapy. Am J Cardiol. 2012;109(5):693–8.

    Article  PubMed  CAS  Google Scholar 

  39. Sica DA, Gehr TWB, Frishman WH. Use of diuretics in the treatment of heart failure in the elderly. Heart Fail Clin J. 2007;3:455–64.

    Article  Google Scholar 

  40. Matsuzaki M, Hori M, Izumi T, Furunami M. Efficacy and safety of tolvaptan in heart failure patients with volume overload despite the standard treatment with conventional diuretics: a phase III, randomized, double-blind, placebo-controlled study (QUEST study). Cardiovasc Drugs Ther. 2011;25(Suppl. 1):S33–45.

    Article  PubMed  CAS  Google Scholar 

  41. Aronow WS. Treatment of systolic and diastolic heart failure in the elderly. J Am Med Dir Assoc. 2006;7:29–36.

    Article  PubMed  Google Scholar 

  42. Dinsdale C, Wani M, Steward J, et al. Tolerability of sprinolactone as an adjunctive treatment for heart failure in patients over 75 years of age. Age Ageing. 2005;34:395–8.

    Article  PubMed  Google Scholar 

  43. The SOLVD investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive heart failure. N Engl J Med. 1991;325:293–302.

    Article  Google Scholar 

  44. Cohn NJ, Tognoni G, for the Valsartan heart failure trial investigators. A randomized trial of the angiotensin-receptor blocker valsartan on chronic heart failure. N Engl J Med. 2001;345:1667–75.

    Article  PubMed  CAS  Google Scholar 

  45. Granger CB, McMurray JJ, Yusuf S, et al. Effects of candesartan in patients with chronic heart failure and reduced left ventricular systolic function, intolerant to angiotensin-converting-enzyme inhibitors: The CHARM ALTERNATIVE trial. Lancet. 2003;362:772–6.

    Article  PubMed  CAS  Google Scholar 

  46. Pitt B, Poole-Wilson PA, Segal R, et al. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure randomized trial—The Losartan Heart Failure Survival Study ELITE II. Lancet. 2000;355:1582–7.

    Article  PubMed  CAS  Google Scholar 

  47. Dickstein K, Kjershus J, OPTIMAAL steering committee of the OPTIMAAL study group. Effects of losartan and captopril on mortality and morbidity in high risk patients after acute myocardial infarction: The OPTIMAAL randomized trial. Optimal trial in Myocardial Infarction with Angiotensin II antagonist Losartan. Lancet. 2002;360(9335):752–60.

    Article  PubMed  CAS  Google Scholar 

  48. Pfeffer MA, McMurray JJV, Velazquez EJ, et al. Valsartan, capropril or both in myocardial infarction complicated by heart failure, left ventricular dysfunction or both. N Engl J Med. 2003;349(20):1893–906.

    Article  PubMed  CAS  Google Scholar 

  49. Gambassi G, Lapane KL, Sgadari A, Carbonin P, Gatsonis C, Lipsitz LA, Mor V, Bernabei R. Effects of angiotensin-converting enzyme inhibitors and digoxin on health outcomes of very old patients with heart failure. Arch Intern Med. 2000;160:53–60.

    Article  PubMed  CAS  Google Scholar 

  50. Hutcheon SD, Gillespie ND, Crombie IK, Struthers AD, McMurdo MET. Perindopril improves six minute walking distance in older patients with left ventricular systolic dysfunction: a randomised double blind placebo controlled trial. Heart. 2002;88:373–7.

    Article  PubMed  CAS  Google Scholar 

  51. Ahmed A, Eiefe CI, Allman RM, et al. Survival benefits of angiotensin converting enzyme inhibitors in older heart failure patients with perceived contraindications. J Am Geriatr Soc. 2002;50:1659–66.

    Article  PubMed  Google Scholar 

  52. Warner KK, Visconti JA, Tschampel MM. Angiotensin II receptor blockers in patient with ACE-inhibitor induced angioedema. Ann Pharmacother. 2000;34:526–8.

    Article  PubMed  CAS  Google Scholar 

  53. Mc Murray JJ, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-added trial. Lancet. 2003;362:767–71.

    Article  CAS  Google Scholar 

  54. White HD, Aylward PE, Huang Z, et al. Mortality and morbidity remain high despite captopril and/or valsartan therapy in elderly patients with left ventricular systolic dysfunction, heart failure or both after acute myocardial infarction: results from the Valsartan in Acute Myocardial Infarction Trial (VALIANT). Circulation. 2005;112:3391–9.

    Article  PubMed  CAS  Google Scholar 

  55. Kasama S, Toyama T, Sumino H, et al. Additive effects of spironolactone and candesartan on cardiac sympathetic nerve activity and left ventricular remodeling in patients with congestive heart failure. J Nucl Med. 2007;48:1993–2000.

    Article  PubMed  CAS  Google Scholar 

  56. Aronow WS, Kronzon I. Effect of enalapril on congestive heart failure treated with diuretics in elderly patients with prior myocardial infarction and normal left ventricular ejection fraction. Am J Cardiol. 1993;71:602–4.

    Article  PubMed  CAS  Google Scholar 

  57. Kitzman DW, Hundley WG, Brubaker PH, et al. A randomized double-blind trail of enalapril in older patients with heart failure and preserved ejection fraction: effects on exercise tolerance and aortic distensibility. Circ Heart Fail. 2010;3(4):477–85.

    Article  PubMed  Google Scholar 

  58. Massie BM, Carson PE, Mcmurray JJ, et al. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med. 2008;359:2456–67.

    Article  PubMed  CAS  Google Scholar 

  59. Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left ventricular ejection fraction: the CHARM Preserved Trial. Lancet. 2003;362:777–81.

    Article  PubMed  CAS  Google Scholar 

  60. Cleland JG, Tendera M, Adamus J, et al. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J. 2006;27:2338–45.

    Article  PubMed  CAS  Google Scholar 

  61. Solomon SD, Zile M, Pieske B, et al. The angiotensin receptor nerpilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double blind randomized controlled trial. Lancet. 2012;380:1387–95.

    Article  PubMed  CAS  Google Scholar 

  62. Gu J, Noe A, Chandra P, et al. Pharmacokinetics and pharmacodynamics of LCZ 696, a novel dual- acting angiotensin receptor neprilysin inhibitor (ARNi). J Clin Pharmacol. 2010;50:401–14.

    Article  PubMed  CAS  Google Scholar 

  63. Shlipak MG. Pharmacotherapy for heart failure in patients with renal insufficiency. Ann Intern Med. 2003;138:917–24.

    Article  PubMed  CAS  Google Scholar 

  64. Cleland JG, Cohen-Solal A, Aguilar JC, et al. Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey. Lancet. 2002;360:1631–9.

    Article  PubMed  CAS  Google Scholar 

  65. Granger CB, Ertl G, Kuch J, et al. Randomized trial of candesartan cilexitil in the treatment of patients with congestive heart failure and a history of intolerance to angiotensin-converting enzyme inhibitors. Am Heart J. 2000;139:609–17.

    Article  PubMed  CAS  Google Scholar 

  66. McMurray J, Cohen-Solai A, Dietz R, et al. Practical recommendations for the use of ACE inhibitors, beta blockers and spironolactone in heart failure: putting guidelines into practice. Eur J Heart Fail. 2001;3:495–502.

    Article  PubMed  CAS  Google Scholar 

  67. Banach M, Bhatia V, Feller MA, Mujib M, Desai RV, Ahmed MI, Guichard JL, Aban I, Love TE, Aronow WS, White M, Deedwania P, Fonarow G, Ahmed A. Relation of baseline systolic blood pressure and long-term outcomes in ambulatory patients with chronic mild to moderate heart failure. Am J Cardiol. 2011;107(8):1208–14.

    Article  PubMed  Google Scholar 

  68. Dulin BR, Haas SJ, Abraham WT, Krum H. Do elderly systolic heart failure patients from beta blockers to the same extent as the non-elderly? Meta- analysis of >12000 patients in large-scale clinical trials. Am J Cardiol. 2005;95:896–8.

    Article  PubMed  CAS  Google Scholar 

  69. Erdmann E, Lechat P, Verkenne P, Wiemann H. Results from post-hoc analyses of the CIBIS II trial: effect of bisoprolol in high-risk patient groups with chronic heart failure. Eur J Heart Fail. 2001;3:469–79.

    Article  PubMed  CAS  Google Scholar 

  70. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) Lancet 1999;353:2001–7.

    Google Scholar 

  71. Packer M, Coats AJ, Fowler MB, et al. The effect of carvedilol on survival in severe chronic heart failure. N Engl J Med. 2001;344:1651–8.

    Article  PubMed  CAS  Google Scholar 

  72. Flather MD, Shibata MC, Coats AJ, et al. Randomized trial to determine the effect of nebivilol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J. 2005;26:215–25.

    Article  PubMed  CAS  Google Scholar 

  73. Ghio S, Magrini G, Serio A, et al. Effects of nebivolol in elderly heart failure with or without systolic left ventricular dysfunction: results of the SENIORS echocardiographic substudy. Eur Heart J. 2006;27:562–8.

    Article  PubMed  CAS  Google Scholar 

  74. The Beta-Blocker Evaluation of Survival Trial Investigators. A trial of the beta-blocker bucindolol in patients with advanced heart failure. N Engl J Med. 2001;344:1659–67.

    Article  Google Scholar 

  75. Domanski M, Krause-Steinrauf H, Goldman S, et al. Failure of benefit and early hazard of bucindolol for class IV heart failure. J Card Fail. 2003;9:266–77.

    Article  PubMed  CAS  Google Scholar 

  76. Anand I, Fiuzat M, O’Connor C, et al. Impact of baseline volume status and LVEF on all-cause mortality in the BEST trial. J Am Coll Cardiol 2010;55:A37, E360.

    Google Scholar 

  77. White M, Desai RV, Guichard JL, et al. Bucindolol, systolic blood pressure, and outcomes in systolic heart failure: a prespecified posthoc analysis of BEST. Can J Cardiol. 2012;28(3):354–9.

    Article  PubMed  CAS  Google Scholar 

  78. Maeder MT, Kaye DM. Differential impact of heart rate and blood pressure on outcome in patients with heart failure with reduced ejection versus preserved left ventricular ejection fraction. Int J Cardiol. 2012;155(2):249–56.

    Article  PubMed  Google Scholar 

  79. Bohm M, Swedberg K, Komajda M, et al. Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomized placebo-controlled trial. Lancet. 2010;376(9744):888–94.

    Article  Google Scholar 

  80. Wikstrand J, Hjalmarson A, Waagstein F, et al. Dose of metoprolol CR/XL and clinical outcomes in patients with heart failure: Analysis of the experience in Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF). J Am Coll Cardiol. 2002;40:491–8.

    Article  PubMed  CAS  Google Scholar 

  81. Dobre D, Zannad F, Keteylaw SJ et al. Association between resting heart rate, chronotrophic index, and long-term outcomes in patients with heart failure receiving beta-blocker therapy: data from the HF—Action trial. Eur Heart J. 2013 Jan 12 (Epub ahead of print).

  82. Jon deau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blockers CONtinuation vs Interruption in patients with congestive heart failure hospitalized for a decompensation episode. Eur Heart J. 2009;30:2186–92.

    Article  CAS  Google Scholar 

  83. Aronow WS, Ahn C, Kronzon I. Effect of propranolol versus no propranolol on total mortality plus nonfatal myocardial infarction in older patients with prior myocardial infarction, congestive heart failure and left ventricular ejection fraction ≥40 % treated with diuretics plus angiotensin-converting enzyme inhibitors. Am J Cardiol. 1997;80(2):207–9.

    Article  PubMed  CAS  Google Scholar 

  84. Fosbol EL, Seibaek M, Brendorp B, et al. Long- term prognostic importance of resting heart rate in patients with left ventricular dysfunction in connection with either heart failure or myocardial infarction: the DIAMOND study. Int J Cardiol. 2010;140:279–86.

    Article  PubMed  Google Scholar 

  85. Leonetti LR, Celli V, et al. Carvedilol in elderly patients with chronic heart failure, a 12 weeks randomized, placebo controlled open trial. Arch Gerontol Geriatr. 1999;29:275–82.

    Article  Google Scholar 

  86. Willemheimer R, van Veldhuisen DJ, Silke B, et al. Effect of survival and hospitalization of initiating treatment for chronic heart failure with bisoprolol followed by enalapril, as compared with the opposite sequence: results of the randomized Cardiac Insufficiency Bisoprolol Study (CIBIS) III. Circulation. 2005;112:2426–35.

    Article  CAS  Google Scholar 

  87. The effect of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group. N Engl J Med. 1997;336:525–33.

  88. Ahmed A, Rich MW, Fleg JL, et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: the Ancillary Digitalis Investigation Group Trial. Circulation. 2006;114:266–70.

    Article  CAS  Google Scholar 

  89. Rich MW, McSherry F, Williford WO, Yusuf S, for the Digitalis Investigation Group. Effect of age on mortality, hospitalizations and response to digoxin in patients with heart failure. The DIG study. J Am Coll Cardiol. 2001;38:806–13.

    Article  PubMed  CAS  Google Scholar 

  90. Aronow WS. Appropriate use of digoxin in treating older nursing home patients with heart failure. J Am Med Dir Assoc. 2006;7:604–6.

    Article  PubMed  Google Scholar 

  91. Rathore SS, Curtis JP, Wang Y, et al. Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA. 2003;289(7):871–8.

    Article  PubMed  CAS  Google Scholar 

  92. Rathore SS, Wang Y, Krunholz HM. Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med. 2002;347:1403–11.

    Article  PubMed  CAS  Google Scholar 

  93. Cohn JN, Johnson G, Ziesche S, et al. A comparison of enalapril with hydralazine and isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med. 1991;325:303–10.

    Article  PubMed  CAS  Google Scholar 

  94. Taylor AL, Ziesche S, Yancy C, et al. Combination of isosorbide nitrate and hydralazine in blacks with heart failure. N Engl J Med. 2004;351:2049–57.

    Article  PubMed  CAS  Google Scholar 

  95. Setaro JF, Zaret BL, Schulman DS, Black HR, Soufer R. Usefulness of verapamil for congestive heart failure associated with abnormal left ventricular diastolic filling and normal left ventricular systolic performance. Am J Cardiol. 1990;66:981–6.

    Article  PubMed  CAS  Google Scholar 

  96. Border JS, Bohm M, Ford I, et al. Effects of ivabradine on recurrent hospitalization for worsening heart failure in patients with chronic systolic heart failure: the SHIFT study. Eur Heart J. 2012;33(22):2813–20.

    Article  CAS  Google Scholar 

  97. Tousoulis D, Antoniades C, Vassiliadou C, et al. Effects of combined administration of low dose atorvastatin and vitamin E on inflammatory markers and endothelial function in patients with heart failure. Eur J Heart Fail. 2005;7:1126–32.

    Article  PubMed  CAS  Google Scholar 

  98. Vrtovec B, Okrajsek R, Golicnik A, et al. Atorvastatin therapy increases heart rate variability, decreases QT variability, and shortens QTc interval duration in patients with advanced chronic heart failure. J Card Fail. 2005;11:684–90.

    Article  PubMed  CAS  Google Scholar 

  99. Bristow MR, Feldman AM, Saxon LA. Heart failure management using implantable devices for ventricular resynchronization: comparison of medical therapy, pacing and defibrillation in chronic heart failure (COMPANION trial). J Card Fail. 2000;6(3):276–85.

    Article  PubMed  CAS  Google Scholar 

  100. Kjekshus J, Adetrei E, Barrios V, CORONA group, et al. Rosuvastatin in older patients with systolic heart failure. N Engl J Med. 2007;357(22):2248–61.

    Article  PubMed  CAS  Google Scholar 

  101. Tavazzi L, Maggioni AP, Marchioli R, et al. Effect of rosuvastatin in patients with cardiac heart failure (the GISSI-HF trial): a randomized, double- blind, placebo- controlled trial. Lancet. 2008;372(9645):1231–9.

    Article  PubMed  CAS  Google Scholar 

  102. Xu M, Yuan G, Wei F. Effect of atorvastatin in patients with chronic heart failure: insights from randomized clinical trials. Arch Med Sci. 2010;6(6):866–73.

    Article  PubMed  CAS  Google Scholar 

  103. Gastelurrutia P, Lupon J, De Antonio M, et al. Statins in heart failure: the paradox between large randomized clinical trials and real life. Mayo Clin Proc. 2012;87(6):555–60.

    Article  PubMed  CAS  Google Scholar 

  104. Fukuta H, Same DC, Brucks S, Little WC, et al. Statin therapy may be associated with lower mortality in patients with diastolic heart failure: a preliminary report. Circulation. 2005;112:357–63.

    Article  PubMed  CAS  Google Scholar 

  105. Banach M, Mikhailidis DP, Kjeldsen SE, Rysz J. Time for new indications for statins? Med Sci Monit. 2009;15:MS1–5.

    PubMed  CAS  Google Scholar 

  106. Stys T, Lawson WE, Smaldone GC, Stys A. Does aspirin attenuate the beneficial effect of angiotensin converting enzyme inhibition in heart failure. Arch Intern Med. 2000;160(10):1409–13.

    Article  PubMed  CAS  Google Scholar 

  107. Al-Khadra AS, Salem DW, Rand WM, et al. Warfarin anticoagulation and survival: a cohort analysis from the Studies of Left Ventricular Dysfunction. J Am Coll Cardiol. 1998;31(4):7749–53.

    Article  Google Scholar 

  108. Massie BM, Collins JF, Ammon SE, WATCH Trial Investigators, et al. Randomized trial of warfarin, aspirin and clopidogrel in patients with heart failure: the Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial. Circulation. 2009;119(12):1616–24.

    Article  PubMed  CAS  Google Scholar 

  109. Homma S, Thompson LPJ, Pullicino PM, et al. Warfarin and aspirin in patients with heart failure and sinus rhythm. N Engl J Med. 2012;366(20):1859–69.

    Article  PubMed  CAS  Google Scholar 

  110. Shore S, Aggarwal, V, Zolty R. Chronic anticoagulation and long term mortality in patients presenting for heart failure with preserved ejection fraction (HFPEF). J Am Coll Cardiol 2012;59(13): E1038.

  111. Talameh JH, McLeod HL, Adams KF Jr, Patterson JH. Genetic tailoring of pharmacotherapy in heart failure: optimize the old, while we wait for something new. J Card Fail. 2012;18(4):338–49.

    Article  PubMed  CAS  Google Scholar 

  112. Braunstein JB, Anderson GF, Gerstenblith G, et al. Non-cardiac co-morbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. J Am Coll Cardiol. 2003;42:1226–33.

    Article  PubMed  Google Scholar 

  113. Dahlstrom U. Frequent non-cardiac co-morbidities in patients with chronic heart failure. Eur J Heart Fail. 2005;7(3):309–16.

    Article  PubMed  Google Scholar 

  114. Mogensen UM, Ersbol M, Andersen M, et al. Clinical characteristics and major co-morbidities in heart failure patients more than 85 years of age compared with younger age group. Eur J Heart Fail. 2011;13(11):1216–23.

    Article  PubMed  Google Scholar 

  115. Stein GY, Kremer A, Shochat T, et al. The diversity of heart failure in a hospitalized population: the role of age. J Card Fail. 2012;18(8):645–53.

    Article  PubMed  Google Scholar 

  116. Caughey GE, Roughead EE, Shakib B, et al. Comorbidity and potential treatment conflicts in the elderly with heart failure: a retrospective, cross-sectional study of administrative claims data. Drugs Aging. 2011;28(7):575–81.

    Article  PubMed  Google Scholar 

  117. Kosiborod M, Smith GL, Radford MJ, et al. The prognostic importance of anemia in patients with heart failure. Am J Med. 2003;114:112–9.

    Article  PubMed  Google Scholar 

  118. Mascarenhas J, Lourenco P, Lopes R, et al. Chronic obstructive pulmonary disease in heart failure: prevalence, therapeutic and prognostic implications. Am Heart J. 2008;155:521–5.

    Article  PubMed  Google Scholar 

  119. Page J, Henry D. Consumption of NSAID’s and the development of congestive heart failure in elderly patients: an under recognized public health problem. Arch Intern Med. 2000;160:777–84.

    Article  PubMed  CAS  Google Scholar 

  120. Witte KK, Clark AL. Beta-blockers and inspiratory pulmonary function in chronic heart failure. J Card Fail. 2005;11:112–6.

    Article  PubMed  CAS  Google Scholar 

  121. Packard K, Wurdeman R, Arouni A. ACE-inhibitor induced bronchial reactivity in patients with respiratory dysfunction. Ann Pharmacother. 2002;36:1058–67.

    Article  PubMed  CAS  Google Scholar 

  122. Maeder MT, Rickli H, Pristerer ME, TIME-CHF investigators, et al. Incidence, clinical predictors, and prognostic impact of worsening renal function in elderly patients with chronic heart failure on intensive medical therapy. Am Heart J. 2012;163(3):407–14.

    Article  PubMed  Google Scholar 

  123. Anker SD, Comin Colet J, Filippatos G, for the Fair-HF Trial Investigators, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361:2436–48.

    Article  PubMed  CAS  Google Scholar 

  124. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. JAMA. 1996;275:852–7.

    Article  PubMed  CAS  Google Scholar 

  125. Ko DT, Herbert PR, Coffey CS. Beta-blocker therapy and symptoms of depression, fatigue and sexual depression. JAMA. 2002;288(3):351–7.

    Article  PubMed  CAS  Google Scholar 

  126. Vaccarino V, Kasi SV, Abramson J, Krumholz HM. Depressive symptoms and risk of functional decline and death in patients with heart failure. J Am Coll Cardiol. 2001;38:199–205.

    Article  PubMed  CAS  Google Scholar 

  127. Elkman I, Fagerberg B, Skoog I. The clinical implications of cognitive impairment in elderly patients with chronic heart failure. J Cardiovasc Nurs. 2001;16:47–55.

    Article  Google Scholar 

  128. Vogels RL, Scheltens P, Schroeder-Tanka JM, et al. Cognitive impairment in heart failure: a systematic review of the literature. Eur J Heart Fail. 2007;9:440–9.

    Article  PubMed  Google Scholar 

  129. Tevendale E, Baxter J. Heart failure comorbidities at the end of life. Curr Opin Support Palliat Care. 2011;5(4):322–6.

    Article  PubMed  Google Scholar 

  130. Brunner-La Ricca HP, Rickenbacher P, Muzzarelli S, et al. End of life preferences of elderly patients with chronic heart failure. Eur Heart J. 2012;33:752–9.

    Article  Google Scholar 

  131. Johnson D, Jin Y, Quan H, Cujec B. Beta-blockers and angiotensin converting enzyme inhibitors/receptor blockers prescription after hospital discharge for heart failure are associated with decreased mortality in Alberta, Canada. J Am Coll Cardiol. 2003;42:1438–45.

    Article  PubMed  Google Scholar 

  132. Tsuyuki RT, Ackman ML, Montague TJ, et al. Effects of 1994 Canadian cardiovascular clinical practice guidelines for congestive heart failure. Can J Cardiol. 2002;18:147–52.

    PubMed  Google Scholar 

  133. Sin DD, McAlister FA. The effects of beta-blockers on morbidity and mortality in a population based cohort of 11942 elderly patients with heart failure. Am J Med. 2002;113:650–6.

    Article  PubMed  CAS  Google Scholar 

  134. Komadja M, Follath F, Swedberg K, et al. Study group on diagnosis of the working group on heart failure of the European Society of Cardiology. The Euroheart Failure Survey Programme—a survey on the quality of care among patients with heart failure in Europe: Part 2. Treatment. Eur Heart J. 2003;24:464–74.

    Article  Google Scholar 

  135. Litaker LR, Chou JY. Patterns of pharmacologic treatment of congestive heart failure in elderly nursing home residents and related issues: a review of literature. Clin Ther. 2003;25(7):1918–35.

    Article  PubMed  CAS  Google Scholar 

  136. Ahmed A. American College of Cardiology/American Heart Association chronic heart failure evaluation and management guidelines: relevance to geriatric practice. J Am Geriatr Soc. 2003;51:123–6.

    Article  PubMed  Google Scholar 

  137. Gambassi G, et al. Management of heart failure among very old persons living in long-term care: has the voice of trials spread? The SAGE Study Group, Part 1. Am Heart J. 2000;139(1):85–93.

    Article  PubMed  CAS  Google Scholar 

  138. Litaker LR, Chou JY. Patterns of pharmacologic treatment of congestive heart failure in elderly nursing home residents and related issues: a review of literature. Clin Ther. 2003;25(7):1918–35.

    Article  PubMed  CAS  Google Scholar 

  139. Komajda M, Hanon O, Hochadel M, et al. Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II. Eur Heart J. 2009;30:478–86.

    Article  PubMed  Google Scholar 

  140. Mahony DO, Cherubini A, Petrovic M. Optimizing pharmacotherapy in older adults, a European perspective. Drugs Aging. 2012;29(6):423–5.

    Article  Google Scholar 

  141. Konstam MA, Gheorghiade M, Burnett JC, et al. Effect of oral tolvaptan in patients hospitalized with worsening heart failure: the EVEREST outcome trial. JAMA. 2007;297:1319–31.

    Article  PubMed  CAS  Google Scholar 

  142. Dittrich HC, Gupta DK, Hack TC, et al. The effect of KW-3902, an adenosine A1 receptor antagonist on renal function and renal plasma flow in ambulatory patients with heart failure and renal impairment. J Card Fail. 2007;13:609–17.

    Article  PubMed  CAS  Google Scholar 

  143. Funaya H, Kitakaze M, Node K, et al. Plasma adenosine levels increase in patients with chronic heart failure. Circulation. 1997;95:1363–5.

    Article  PubMed  CAS  Google Scholar 

  144. Nagayama T, Hsu S, Zhang M, et al. Sildenafil stops progressive chamber, cellular and molecular remodeling and improves calcium handling and function in heart with preexisting hypertrophy caused by pressure overload. J Am Coll Cardiol. 2009;53:207–15.

    Article  PubMed  CAS  Google Scholar 

  145. Guazzi M, Sumaja M, Arena R, et al. Long-term use of sildenafil in the therapeutic management of heart failure. J Am Coll Cardiol. 2007;50:2138–44.

    Google Scholar 

  146. Andersen MJ, Ersbell M, Axelsson A, et al. Sildenafil and diastolic dysfunction after acute myocardial infarction in patients with preserved ejection fraction: the sildenafil and diastolic dysfunction after acute myocardial infarction (SIDAMI) trial. Circulation. 2013;127(4):1200–8.

    Article  PubMed  CAS  Google Scholar 

  147. Redfield MM, Borlaug BA, Lewis GD, et al. Phosphodiesterase-5 inhibition to improve clinical status and exercise capacity in diastolic heart failure (RELAX) trial: rationale and design. Circ Heart Fail. 2012;5:653–9.

    Article  PubMed  Google Scholar 

  148. Aronson D, Krum H. Novel therapies in acute and chronic heart failure. Pharmacol Ther. 2012;135(1):1–17.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

None.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Geriatric Medicine, Department of Medicine, University of Alberta, B139N Clinical Sciences Building, 8440-112 Street, Edmonton, AB, T6G 2G3, Canada

    Kannayiram Alagiakrishnan

  2. Department of Hypertension, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland

    Maciej Banach

  3. Section of Geriatrics, Veterans Affairs Medical Center, Birmingham, AL, USA

    Linda G. Jones & Ali Ahmed

  4. Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Linda G. Jones & Ali Ahmed

  5. Division of Cardiology, Geriatrics and Pulmonary/Critical Care, Department of Medicine, New York Medical College, Valhalla, NY, USA

    Wilbert S. Aronow

Authors
  1. Kannayiram Alagiakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maciej Banach
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Linda G. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ali Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wilbert S. Aronow
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kannayiram Alagiakrishnan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alagiakrishnan, K., Banach, M., Jones, L.G. et al. Medication Management of Chronic Heart Failure in Older Adults. Drugs Aging 30, 765–782 (2013). https://doi.org/10.1007/s40266-013-0105-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-013-0105-9

Keywords

Search

Navigation