Treatment of Congestive Heart Failure in the Elderly

  • Gaspare Parrinello
  • Pietra Amato
  • Anna Licata
  • Salvatore Paterna
  • Antonio Pinto
  • Ligia J. Dominguez
  • Mario Barbagallo
  • Giuseppe Licata


Congestive heart failure (CHF) is a complex clinical syndrome which constitutes the epilogue of the natural history of virtually all heart diseases and in its advanced stages, has a poor prognosis. In the elderly, heart failure exhibits particular characteristics linked to the age-related alterations of cardiovascular system, to the association with other pathologies, to the atypical clinical presentation and to the increased iatrogenic risk. Heart failure now afflicts over 1% of the general population with nearly 1 in 10 elderly subjects affected, and the frequency of CHF is progressively increasing in most industrialized societies1,2. Further, CHF remains a significant cause of death and hospitalization especially among elderly populations. As such, 37,927 deaths and 722,000 hospital discharges were attributed to heart failure in 1990 (Fig. 1).3 Therefore, continued efforts are needed for the primary and secondary prevention of this syndrome.


Heart Failure Congestive Heart Failure Idiopathic Dilate Cardiomyopathy Isosorbide Dinitrate Vascular Smooth Muscle Cell Proliferation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kannel WB, Ho K, Thom T. Changing epidemiological features of cardiac failure. Br Heart J 1994;72:(Suppl):S3–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Licata G. Moderni orientamenti terapeutici nello scompenso cardiaco congestizio. G Clin Med 1991;LXXII:489–506.Google Scholar
  3. 3.
    Gillum RF. Epidemiology of heart failure in the United States. Am Heart J 1993;126:1042–1047.PubMedCrossRefGoogle Scholar
  4. 4.
    Narang R, Cleland JGF, Erhardt L, et al. Mode of death in chronic heart failure. A request and proposition for more accurate classification. Eur Heart J 1996;17:1390–1403.PubMedCrossRefGoogle Scholar
  5. 5.
    Taylor SH. Congestive heart failure. Towards a comprehensive treatment. Eur Heart J 1996; 17 (suppl. B):43–56.PubMedCrossRefGoogle Scholar
  6. 6.
    Cohn JN. Current therapy of the failing heart. Circulation 1988; 78:1099–1107.PubMedCrossRefGoogle Scholar
  7. 7.
    Cohn JN, Levine TB, Olivari M.T. et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 1984;311:819–823PubMedCrossRefGoogle Scholar
  8. 8.
    Sigurdsson A, Swedberg K. Neurohormonal activation and congestive heart failure: today’s experience with ACE inhibitors and rationale for their use. Eur Heart J, 1995; 16(suppl.N): 65–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Ellison DH. The physiologic basis of diuretic synergism: its role in treating diuretic resistance. Ann Int Med 1991;114:886–894.PubMedCrossRefGoogle Scholar
  10. 10.
    Dormans TPJ, Gerlag PGG. Combination of high-dose furosemide and hydrochlorothiazide in the treatment of refractory congestive heart failure. Eur Heart J 1996; 17:1867–1874.PubMedCrossRefGoogle Scholar
  11. 11.
    The Captopril-Digoxin Multicenter Research Group: Comparative effects of therapy with Captopril and Digoxin in patients with mild to moderate heart failure. JAMA 1988; 259:539–544.CrossRefGoogle Scholar
  12. 12.
    Packer M., Gheorghiade M, Young JB, for the RADIANCE Investigators. Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting enzyme inhibitors. N Engl J Med 1993;329:1–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Uretsky BF, Young JB, Shahidi FE, et al. Randomized study assessing the effect of digoxin withdrawal in patients with mild to moderate chronic heart failure: results of the PROVED trial. J Am Coll Cardiol 1993;22:955–962.PubMedCrossRefGoogle Scholar
  14. 14.
    The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 1997;336:525–534.CrossRefGoogle Scholar
  15. 15.
    Covit AB, Schaer GL, Sealey JE, Cody RJ, Laragh J. Suppression of the renin-angiotensin system by intravenous digoxin in congestive heart failure. Am J Med 1983;75:445–447.PubMedCrossRefGoogle Scholar
  16. 16.
    Ferguson DW, Abboud FM, Mark AL. Selective impairment of baroreceptor mediated vasoconstrictor responses in patients with ventricular dysfunction. Circulation 1984;69:451–460.PubMedCrossRefGoogle Scholar
  17. 17.
    Strickler JC, Kessler RH. Direct renal action of some digitalis steroids. J Clin Invest 1961;40:311–319.PubMedCrossRefGoogle Scholar
  18. 18.
    Aronow WS, Starling I, Etienne F. Lack of efficacy of digoxin in treatment of compensated congestive heart failure with third heart sound and sinus rhythm in elderly patients receiving diuretic therapy. Am J Cardiol 1986;58:168–169.PubMedCrossRefGoogle Scholar
  19. 19.
    Leier CV, Huss P, Magorien RD, Unverferth DV. Improved exercise capacity and differing arterial and venous tolerance during chronic isosorbide dinitrate therapy for congetive heart failure. Circulation 1983; 67:817–822.PubMedCrossRefGoogle Scholar
  20. 20.
    Franciosa JA, Goldsmith SR, Cohn JN. Contrasting immediate and long-term effects of isosorbide dinitrate on exercise capacity in congestive heart failure. Am J Med 1980;69:559–566.PubMedCrossRefGoogle Scholar
  21. 21.
    Packer M, for the prospective Randomized Amlodipine Survival Evaluation Study Group. Effect of amlodipine on morbidity and mortality in severe chronic heart failure N Engl J Med 1996;335:1107–1114.PubMedCrossRefGoogle Scholar
  22. 22.
    Boden WE, Ziesche S., Carson PE et al. Rationale and design of the third vasodilator-heart failure trial (V-HeFTIII): felodipine as adjunctive therapy to enalapril and loop diuretics with or without digoxin in chronic heart failure. V-HeFT III investigators. Am J Cardiol 1996;77:1078–82.PubMedCrossRefGoogle Scholar
  23. 23.
    Fisher ML, Gottlieb SS, Plotnik G, et al. Beneficial effects of metoprolol in heart failure associated with coronary artery disease: a randomized trial. J Am Coll Cardiol 1994;23:943–50.PubMedCrossRefGoogle Scholar
  24. 24.
    Krum H, Sackner-Bernstein JD, Goldsmith RL, et al. Double-blind, placebo-controlled study of the long-term efficacy of Carvedilol in patients with severe chronic heart failure. Circulation 1995;92:1499–1506.PubMedCrossRefGoogle Scholar
  25. 25.
    Gilbert EM, Anderson JL, Deitchman D, et al. Chronic β-blocker-vasodilator therapy improves cardiac function in idiopathic dilated cardiomyopathy: a double-blind, randomized study of bucindolol versus placebo. Am J Med 1990;88:223–229.PubMedCrossRefGoogle Scholar
  26. 26.
    Wisenbaugh T, Katz I, Davis J, et al. Long term (3 month) effects of a new beta-blocker (nebivolol) on cardiac perfomance in dilated cardiomyopathy. J Am Coll Cardiol 1993;21:1094–1100.PubMedCrossRefGoogle Scholar
  27. 27.
    Bristow MR, O’Connell JB, Gilbert EM, et al. For the bucindolol Investigators. Dose response of chronic β-blocker treatment in heart failure from either idiopathic dilated cardiomyopathy or ischemic cardiomyopathy. Circulation 1994;89:1632–1642.PubMedGoogle Scholar
  28. 28.
    Metra M, Nardi M, Giubbini R, Dei Cas L. Effects of short-and long-term Carvedilol administration on rest and exercise capacity and clinical conditions in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol 1994;24:1678–1687.PubMedCrossRefGoogle Scholar
  29. 29.
    Waagstein F, Bristow M.R., Swedberg K, et al. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet 1993;342:1441–1446.PubMedCrossRefGoogle Scholar
  30. 30.
    CIBIS Investigators and Committees. A randomized trial of β-blockade in heart failure: the Cardiac Insufficiency Bisoprolol Study (CIBIS). Circulation 1994;90:1765–1773.CrossRefGoogle Scholar
  31. 31.
    Chadda K, Goldstein S, Byington R, Curd JD. Effect of propanolol after myocardial infarction in patients with congestive heart failure Circulation 1986;73:503–510.PubMedCrossRefGoogle Scholar
  32. 32.
    Merlino G, Scaglione R, Corrao S, et al. Association between reduced lymphocyte β-adrenergic receptors and left ventricular dysfunction in young obese subjects. Int J Obesity 1994;18:699–703.Google Scholar
  33. 33.
    Merlino G, Scaglione R, Paterna S, et al. Lymphocyte β-adrenergic receptors in young subjects with peripheral or central obesity: relationship with central hemodynamics and left ventricular function. Eur Heart J 1994;15:786–794.PubMedGoogle Scholar
  34. 34.
    Yue T-L, Cheng HY, Lysko PG, et al. Carvedilol, a new vasodilator and β-adrenoceptor antagonist, is an antioxidant and free radical scavenger. J Pharmacol Exp Ther 1992;263:92–98.PubMedGoogle Scholar
  35. 35.
    Ohlstein EH, Douglas SA, Sung C-P, et al. Carvedilol, a cardiovascular drug, prevents vascular smooth muscle cell proliferation, migration and neointimal formation following vascular injury. Proc Natl Acad Sci USA 1993;90:6189–6193.PubMedCrossRefGoogle Scholar
  36. 36.
    Consensus Trial Study Group. Effect of Enalapril on mortality in severe congestive heart failure: results of Cooperative North Scandinavian Enalapril Survival Study. N Engl J Med 1987;316:1429.CrossRefGoogle Scholar
  37. 37.
    The SOLVD Investigators. Effect of Enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991;325:293–302CrossRefGoogle Scholar
  38. 38.
    Cohn JN Johnson G., Ziesche S, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991;325:303–10PubMedCrossRefGoogle Scholar
  39. 39.
    Pfeffer MA et al. ACM and SAVE Investigators: Effect of Captopril on mortality and morbidity in patients with left ventricular disfunction after myocardial infarction: Result of the Survival and Ventricular Enlargement Trial. New Engl J Med 1992:327:669–77.PubMedCrossRefGoogle Scholar
  40. 40.
    Cleland JGF, Erhardt L, Murray G, Halls AS, Balls SG. Effect of ramipril on morbidity and mode of death among survivors of acute myocardial infarction with clinical evidence of heart failure. A report from the AIRE study Investigators. Eur Heart J 1997;18:41–51.PubMedCrossRefGoogle Scholar
  41. 41.
    Hughes CV, Wong M, Jonhson G, et al. Influence of age on mechanisms and prognosis of heart failure. Circulation 1993;87(Suppl VI): 111–117.Google Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Gaspare Parrinello
    • 1
  • Pietra Amato
    • 1
  • Anna Licata
    • 1
  • Salvatore Paterna
    • 1
  • Antonio Pinto
    • 1
  • Ligia J. Dominguez
    • 1
  • Mario Barbagallo
    • 1
  • Giuseppe Licata
    • 1
  1. 1.Istituto di Medicina InternaUniversity of PalermoItaly

Personalised recommendations