Skip to main content
SpringerLink
Log in

Reperfusion and Vasodilator Therapy in Elderly Patients with STEMI and Heart Failure: Improving Outcomes

  • Chapter
  • First Online:
Aging and Heart Failure

  • 1713 Accesses

Abstract

The elderly population (aged ≥65 years) has been increasing worldwide. Heart failure (HF) is also common and increasing in the elderly. Cardiovascular (CV) changes with aging predispose the elderly to HF. Comorbidities such as coronary artery disease with ST-segment-elevation myocardial infarction (STEMI) and hypertension (HTN) are more prevalent in the elderly and contribute to the development of HF. Morbidity, hospitalizations, and costs associated with HF are higher in the elderly. Despite improved therapies, the bulk of CV deaths occur in the elderly. Survivors of STEMI develop progressive left ventricular (LV) remodeling and HF with low ejection fraction (HF/Low-EF), while those with HTN develop HF with preserved ejection fraction (HF/PEF). Reasons for the increased HF burden in the elderly include the lack of clinical trial data in elderly patients for specific therapy of adverse remodeling, healing, and HF/low-EF post-STEMI and HF/PEF. Recommendations for reperfusion and vasodilator therapies for the management of HF are based on studies done in mostly younger populations. While reperfusion has many benefits, aging may enhance reperfusion damage, impair healing, and enhance adverse remodeling after STEMI. While vasodilators are attractive agents for their LV unloading and anti-remodeling effects, caution is needed because of aging-related changes affecting the responses in the elderly. This chapter focuses on the roles of reperfusion and vasodilator therapies in the management of HF in elderly survivors of STEMI and chronic HTN and discusses some reasons for the increasing HF burden in that population and some possible ways for improving outcomes, especially in the older-elderly aged ≥75 years.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jugdutt BI. Aging and heart failure: changing demographics and implications for therapy in the elderly. Heart Fail Rev. 2010;15:401–5.

    PubMed  Google Scholar 

  2. Jugdutt BI. Heart failure in the elderly: advances and challenges. Expert Rev Cardiovasc Ther. 2010;8:695–715.

    PubMed  Google Scholar 

  3. Weisfeldt ML, editor. The aging heart. Its function and response to stress. Aging. vol. 12. New York, NY: Raven Press; 1980.

    Google Scholar 

  4. Lakatta EG, Gerstenblith G, Weisfeldt ML. The aging heart: Structure, function, and disease. In: Braunwald E, editor. Heart Disease. Philadelphia, PA: Saunders; 1997. p. 1687–700.

    Google Scholar 

  5. Cheitlin MD, Zipes DP. Cardiovascular disease in the elderly. In: Zipes DP, Libby P, editors. Braunwald’s Heart Disease. A Textbook of Cardiovascular Medicine, vol. 2. Philadelphia, PA: Saunders Elsevier; 2001. p. 2019–37.

    Google Scholar 

  6. Lakatta E. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises. Parts I, II and III. Circulation. 2003;107:139–146; 346–354; 490–497

    Google Scholar 

  7. Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics – 2010 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2010;121:e1–e170.

    Google Scholar 

  8. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics-2012 update: a report from the American Heart Association. Circulation. 2012;125:e2–e220.

    PubMed  Google Scholar 

  9. Go AS, Mozaffarian D, Roger VL, American Heart Association Statistics Committee and Stroke Statistics Subcommittee, et al. Heart disease and stroke statistics-2013 update. A report from the American Heart Association. Circulation. 2013;127:e6–e245.

    PubMed  Google Scholar 

  10. Ho KK, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham study. J Am Coll Cardiol 1993;22(Suppl A):6A–13A.

    Google Scholar 

  11. Heidenreich PA, Albert NM, Allen LA, American Heart Association Advocacy Coordinating Committee, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Radiology and Intervention, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Stroke Council, et al. Forecasting the impact of heart failure in the United States: A policy statement from the American Heart Association. Circ Heart Fail. 2013;6:606–29.

    CAS  PubMed  Google Scholar 

  12. Jugdutt BI. Prevention of heart failure in the elderly: when, where and how to begin. Heart Fail Rev. 2012;15:531–44.

    Google Scholar 

  13. Bureau. UC. U.S. Census Bureau, 2007, U.S. Interim Projections by age; 2007.

    Google Scholar 

  14. Rich MW. Epidemiology, clinical features, and prognosis of acute myocardial infarction in the elderly. Am J Geriatr Cardiol. 2006;15:7–11.

    PubMed  Google Scholar 

  15. Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to update the 2001 guidelines for the evaluation and management of heart failure. Circulation. 2005;112:e154–235.

    PubMed  Google Scholar 

  16. Jessup M, Abraham WT, Casey DE, et al. 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task force on practice guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119:1977–2016.

    PubMed  Google Scholar 

  17. Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Eur J Heart Fail. 2008;19:2388–442.

    Google Scholar 

  18. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for management of heart failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013. Published online June 5, 2013. http://circ.ahajournals.org/content/early/2013/06/03/CIR.0b013e31829e8776.citation.

  19. Alexander KP, Newby LK, Armstrong PW, et al. Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation. 2007;115:2570–89.

    PubMed  Google Scholar 

  20. Jugdutt BI. Aging and remodeling during healing of the wounded heart: current therapies and novel drug targets. Curr Drug Targets. 2008;9:325–44.

    CAS  PubMed  Google Scholar 

  21. St John Sutton M, Pfeffer MA, Moye L, et al. Cardiovascular death and left ventricular remodeling two years after myocardial infarction: baseline predictors and impact of long-term use of captopril: information from the Survival and Ventricular Enlargement (SAVE) trial. Circulation 1997;96:3294–3299

    Google Scholar 

  22. Jelani A, Jugdutt BI. STEMI and heart failure in the elderly: role of adverse remodeling. Heart Fail Rev. 2010;15:513–21.

    PubMed  Google Scholar 

  23. Fleg JL, Strait J. Age-associated changes in cardiovascular structure and function in the elderly: a fertile milieu for future disease. Heart Fail Rev. 2012;17:563–71.

    Google Scholar 

  24. Man J, Tymchak W, Jugdutt BI. Adjunctive pharmacologic treatment for acute myocardial infarction. In: Brown DL, Jeremias A, editors. Textbook of Cardiac Intensive Care. 2nd ed. Philadelphia, PA: Elsevier; 2010. p. 1–72.

    Google Scholar 

  25. Man JP, Jugdutt BI. Systolic heart failure in the elderly: optimizing medical management. Heart Fail Rev. 2012;17:563–71.

    PubMed  Google Scholar 

  26. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary. A report of the American College of cardiology Foundation/American Heart Association task force on practice guidelines. Circulation. 2013;127(4):529–55.

    PubMed  Google Scholar 

  27. Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 Expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Coll Cardiol. 2011;57(20):2037–114.

    PubMed  Google Scholar 

  28. McMurray JJ, Stewart S. Epidemiology, aetiology, and prognosis of heart failure. Heart. 2000;83:596–602.

    CAS  PubMed  Google Scholar 

  29. Mendez GF, Cowie MR. The epidemiological features of heart failure in developing countries: a review of the literature. Int J Cardiol. 2001;80:213–9.

    CAS  PubMed  Google Scholar 

  30. World Health Organization (WHO). Definition of an older or elderly person. 2013. http://www.who.int/healthinfo/survey/ageingdefnolder/en/. Last Accessed 26 Aug 2013.

  31. Jugdutt BI. Clinical effectiveness of telmisartan alone or in combination therapy for controlling blood pressure and vascular risk in the elderly. Clin Interv Aging. 2010;5:403–16.

    CAS  PubMed Central  PubMed  Google Scholar 

  32. Ni H. Prevalence of self-reported heart failure among US adults: results from the 1999 National Health Interview Survey. Am Heart J. 2003;146:1–4.

    Google Scholar 

  33. Gottdiener JS, Arnold AM, Aurigemma GP, et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol. 2000;35:1628–37.

    CAS  PubMed  Google Scholar 

  34. McCullough PA, Khandelwal AK, McKinnon JE, et al. Outcomes and prognostic factors of systolic as compared with diastolic heart failure in urban America. Congest Heart Fail. 2005;11:6–11.

    PubMed  Google Scholar 

  35. McDonald K. Diastolic heart failure in the elderly: underlying mechanisms and clinical relevance. Int J Cardiol. 2008;125:197–202.

    PubMed  Google Scholar 

  36. Tehrani F, Phan A, Chien CV, et al. Value of medical therapy in patients >80 years of age with heart failure and preserved ejection fraction. Am J Cardiol. 2009;103:829–33.

    PubMed  Google Scholar 

  37. Lloyd-Jones DM, Larson MG, Leip EP, et al. Framingham heart study. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation. 2002;106:3068–72.

    PubMed  Google Scholar 

  38. Roger VL, Weston SA, Redfield M, et al. Trends in heart failure incidence and survival in a community-based population. JAMA. 2004;292:344–50.

    CAS  PubMed  Google Scholar 

  39. Schwartz JB, Zipes DP. Cardiovascular disease in the elderly. In: Libby P, Bonow RO, Mann DL, Zipes DP, editors. Braunwald’s Heart Disease. A Textbook of Cardiovascular Medicine, vol. 2. Philadelphia, PA: Saunders Elsevier; 2008. p. 1923–53.

    Google Scholar 

  40. Johansen H, Strauss B, Arnold JMO, Moe G, Liu P. On the rise: the current and projected future burden of congestive heart failure hospitalization in Canada. Can J Cardiol. 2003;19:430–5.

    PubMed  Google Scholar 

  41. Fox KF, Cowie MR, Wood DA, et al. Coronary artery disease as the cause of incident heart failure in the population. Eur Heart J. 2001;22:228–36.

    CAS  PubMed  Google Scholar 

  42. Liu P, Arnold JMO, Belenkie I, et al. The 2001 Canadian Cardiovascular Society consensus guideline update for the management and prevention of heart failure. Can J Cardiol 2001;17(Suppl E):5E–25E.

    Google Scholar 

  43. Jugdutt BI. Identification of patients prone to infarct expansion by the degree of regional shape distortion on an early two-dimensional echocardiogram after myocardial infarction. Clin Cardiol. 1990;13:28–40.

    CAS  PubMed  Google Scholar 

  44. Jugdutt BI, Tang SB, Khan MI, Basulado CA. Functional impact of remodeling during healing after non-Q wave versus Q wave anterior myocardial infarction in the dog. J Am Coll Cardiol. 1992;20:722–31.

    CAS  PubMed  Google Scholar 

  45. Jugdutt BI, Khan MI. Impact of increased infarct transmurality on remodelling and function during healing after anterior myocardial infarction in the dog. Can J Physiol Pharmacol. 1992;70:949–58.

    CAS  PubMed  Google Scholar 

  46. Boesma E, Mercado N, Poldermans D, et al. Acute myocardial infarction. Lancet. 2003;361:847–58.

    Google Scholar 

  47. Reimer KA, Lowe JE, Ramussen MM, et al. The wavefront phenomenon of ischemic cell death, 1: myocardial infarct size versus duration of coronary occlusion in dogs. Circulation. 1977;56:786–94.

    CAS  PubMed  Google Scholar 

  48. Jugdutt BI. Prevention of ventricular remodelling post myocardial infarction: timing and duration of therapy. Can J Cardiol. 1993;9:103–14.

    CAS  PubMed  Google Scholar 

  49. Mann DL. Management of Heart Failure Patients with Reduced Ejection Fraction. In: Libby P, Bonow RO, Mann DL, Zipes DP, editors. Braunwald’s Heart Disease. A Textbook of Cardiovascular Medicine, vol. 1. Philadelphia, PA: Saunders Elsevier; 2008. p. 611–40.

    Google Scholar 

  50. Pfeffer MA, Braunwald E. Ventricular remodelling after myocardial infarction. Circulation. 1990;81:1161–72.

    CAS  PubMed  Google Scholar 

  51. Goldberg RJ, McCormick D, Gurwitz JH, et al. Age-related trends in short- and long-term survival after acute myocardial infarction: a 20-year population-based perspective (1975–1995). Am J Cardiol. 1998;82:1311–7.

    CAS  PubMed  Google Scholar 

  52. White HD, Barbash GI, Califf RM, et al. Age and outcome with contemporary thrombolytic therapy. Results from the GUSTO-I trial. Global Utilization of Streptokinase and TPA for Occluded coronary arteries trial. Circulation. 1996;94:1826–33.

    CAS  PubMed  Google Scholar 

  53. Stone PH, Thompson B, Anderson HV, et al. Influence of race, sex, and age on management of unstable angina and non-Q-wave myocardial infarction: the TIMI III registry. JAMA. 1996;275:1104–12.

    CAS  PubMed  Google Scholar 

  54. Rich MW, Bosner MS, Chung MK, et al. Is age an independent predictor of early and late mortality in patients with acute myocardial infarction? Am J Med. 1992;92:7–13.

    CAS  PubMed  Google Scholar 

  55. Goldberg RJ, Yarzebski J, Lessard D, Gore JM. A two-decades (1975 to 1995) long experience in the incidence, in-hospital and long-term case-fatality rates of acute myocardial infarction: a community-wide perspective. J Am Coll Cardiol. 1999;33:1533–9.

    CAS  PubMed  Google Scholar 

  56. Ezekowitz JA, Kaul P, Bakal JA, et al. Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction. J Am Coll Cardiol. 2009;53:13–20.

    PubMed  Google Scholar 

  57. Krumholz HM, Wang Y, Chen J, et al. Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995–2006. JAMA. 2009;302:767–73.

    CAS  PubMed Central  PubMed  Google Scholar 

  58. Boersma E, The Primary Coronary Angioplasty vs. Thrombolysis (PCAT)-2 Trialists’ Collaborative Group. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. Eur Heart J. 2006;27:779–88.

    PubMed  Google Scholar 

  59. Goldenberg I, Matetzky S, Halkin A, et al. Primary angioplasty with routine stenting compared with thrombolytic therapy in elderly patients with acute myocardial infarction. Am Heart J. 2003;145:862–7.

    PubMed  Google Scholar 

  60. de Boer MJ, Ottervanger JP, van’t Hof AW, et al. Reperfusion therapy in elderly patients with acute myocardial infarction: a randomized comparison of primary angioplasty and thrombolytic therapy. J Am Coll Cardiol. 2002;39:1723–8.

    PubMed  Google Scholar 

  61. Bolognese L, Neskovic AN, et al. Left ventricular remodeling after primary coronary angioplasty: patterns of left ventricular dilation and long-term prognostic implications. Circulation. 2002;106:2351–7.

    PubMed  Google Scholar 

  62. Wenger N. Inclusion of elderly individuals in clinical trials. In: Wenger N, editor. Proceedings Cardiovascular disease and cardiovascular therapy as a model. Kansas, MO: Marion Merrell Dow, Inc.; 1993.

    Google Scholar 

  63. Alexander KP, Newby LK, Cannon CP, et al. Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation. 2007;115:2549–69.

    PubMed  Google Scholar 

  64. Lee PY, Alexander KP, Hammill BG, Pasquali SK, Peterson ED. Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA. 2001;286:708–13.

    CAS  PubMed  Google Scholar 

  65. Gurwitz JH, Col NF, Avorn J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA. 1992;268:1417–22.

    CAS  PubMed  Google Scholar 

  66. Nicolosi GL, Golcea S, Ceconi C, et al. Effects of perindopril on cardiac remodelling and prognostic value of pre-discharge quantitative echocardiographic parameters in elderly patients after acute myocardial infarction: the PREAMI echo substudy. Eur Heart J. 2009;30:1656–65.

    CAS  PubMed  Google Scholar 

  67. Bujak M, Kweon HJ, et al. Aging-related defects are associated with adverse cardiac remodeling in a mouse model of reperfused myocardial infarction. J Am Coll Cardiol. 2008;51:1384–92.

    PubMed Central  PubMed  Google Scholar 

  68. Jugdutt BI, Jelani AW. Aging and defective healing, adverse remodeling, and blunted post-conditioning in the reperfused wounded heart. J Am Coll Cardiol. 2008;51:1399–403.

    PubMed  Google Scholar 

  69. Przyklenk K, Maynard M, Darling CE, Whittaker P. Aging mouse hearts are refractory to infarct size reduction with post-conditioning. J Am Coll Cardiol. 2008;51:1393–8.

    PubMed  Google Scholar 

  70. Jugdutt BI. Cyclooxygenase inhibition and adverse remodeling during healing after myocardial infarction. Circulation. 2007;115:288–91.

    PubMed  Google Scholar 

  71. Maggioni AP, Maseri A, Fresco C, et al. Age-related increase in mortality among patients with first myocardial infarctions treated with thrombolysis. The Investigators of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI-2). N Engl J Med. 1993;329:1442–8.

    CAS  PubMed  Google Scholar 

  72. Bueno H, Martinez-Selles M, Perez-David E, Lopez-Palop R. Effect of thrombolytic therapy on the risk of cardiac rupture and mortality in older patients with first acute myocardial infarction. Eur Heart J. 2005;26:1705–11.

    CAS  PubMed  Google Scholar 

  73. Gurwitz JH, McLaughlin TJ, Willison DJ, et al. Delayed hospital presentation in patients who have had acute myocardial infarction. Ann Intern Med. 1997;126:593–9.

    CAS  PubMed  Google Scholar 

  74. Yarzebski J, Goldberg RJ, Gore JM, Alpert JS. Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarction: the Worcester Heart Attack Study. Am Heart J. 1994;128:255–63.

    CAS  PubMed  Google Scholar 

  75. Goldberg RJ, Yarzebski J, Lessard D, Gore JM. Decade-long trends and factors associated with time to hospital presentation in patients with acute myocardial infarction: the Worcester Heart Attack study. Arch Intern Med. 2000;160:3217–23.

    CAS  PubMed  Google Scholar 

  76. Moser DK, Kimble LP, Alberts MJ, et al. Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association Council on cardiovascular nursing and stroke council. Circulation. 2006;114:168–82.

    PubMed  Google Scholar 

  77. Lee KL, Woodlief LH, Topol EJ, et al. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators. Circulation. 1995;91:1659–68.

    CAS  PubMed  Google Scholar 

  78. Woon VC, Lim KH. Acute myocardial infarction in the elderly–the differences compared with the young. Singapore Med J. 2003;44:414–8.

    CAS  PubMed  Google Scholar 

  79. Newby LK, Rutsch WR, Califf RM, et al. Time from symptom onset to treatment and outcomes after thrombolytic therapy. GUSTO-1 Investigators. J Am Coll Cardiol. 1996;27:1646–55.

    CAS  PubMed  Google Scholar 

  80. Dzavik V, Sleeper LA, Picard MH, et al. Outcome of patients aged > or = 75 years in the SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK (SHOCK) trial: do elderly patients with acute myocardial infarction complicated by cardiogenic shock respond differently to emergent revascularization? Am Heart J. 2005;149:1128–34.

    PubMed  Google Scholar 

  81. Sinkovic A, Marinsek M, Svensek F. Women and men with unstable angina and/or non-ST-elevation myocardial infarction. Wien Klin Wochenschr. 2006;118 Suppl 2:52–7.

    PubMed  Google Scholar 

  82. Khalil ME, Heller EN, Boctor F, et al. Ventricular free wall rupture in acute myocardial infarction. J Cardiovasc Pharmacol Therapeut. 2001;6:231–6.

    CAS  Google Scholar 

  83. Hellermann JP, Jacobsen SJ, Reeder GS, et al. Heart failure after myocardial infarction: prevalence of preserved left ventricular systolic function in the community. Am Heart J. 2003;145:742–8.

    PubMed  Google Scholar 

  84. Michaels AD. Risk of stroke after myocardial infarction. N Engl J Med. 1997;336:1916–7.

    CAS  PubMed  Google Scholar 

  85. Ertl G, Frantz S. Healing after myocardial infarction. Cardiovasc Res. 2005;66:22–32.

    CAS  PubMed  Google Scholar 

  86. Jugdutt BI. Ventricular remodeling after infarction and the extracellular collagen matrix: when is enough enough? Circulation. 2003;108:1395–403.

    PubMed  Google Scholar 

  87. Rathore SS, Berger AK, Weinfurt KP, et al. Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. Circulation. 2000;101:969–74.

    CAS  PubMed  Google Scholar 

  88. Kazemian P, Oudit G, Jugdutt BI. Atrial fibrillation and heart failure in the elderly. Heart Fail Rev. 2012;17:597–613.

    PubMed  Google Scholar 

  89. Avezum A, Makdisse M, Spencer F, et al. Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2005;149:67–73.

    PubMed  Google Scholar 

  90. Skolnick AH, Alexander KP, Chen AY, et al. Characteristics, management, and outcomes of 5,557 patients age > or =90 years with acute coronary syndromes: results from the CRUSADE Initiative. J Am Coll Cardiol. 2007;49:1790–7.

    PubMed  Google Scholar 

  91. Pitt B. The role of mineralocorticoid receptor antagonists (MRAs) in very old patients with heart failure. Heart Fail Rev. 2012;17:573–9.

    CAS  PubMed  Google Scholar 

  92. Paulus WJ, Tschöpe C, Sanderson JE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28:2539–50.

    PubMed  Google Scholar 

  93. Redfield MM. Heart failure with normal ejection fraction. In: Libby P, Bonow RO, Mann DL, Zipes DP, editors. Braunwald’s Heart Disease. A Textbook of Cardiovascular Medicine, vol. 1. Philadelphia, PA: Saunders Elsevier; 2008. p. 641–64.

    Google Scholar 

  94. Masoudi FA, Havranek EP, Smith G, et al. Gender, age, and heart failure with preserved left ventricular systolic function. J Am Coll Cardiol. 2003;41:217–23.

    PubMed  Google Scholar 

  95. Larsen PD, Martin JL. Polypharmacy and elderly patients. AORN J 1999;69:619–622, 25, 27–8.

    Google Scholar 

  96. Jones BA. Decreasing polypharmacy in clients most at risk. AACN Clin Issues. 1997;8:627–34.

    CAS  PubMed  Google Scholar 

  97. Gheorghiade M, Abraham WT, Albert NM, et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA. 2006;296:2217–26.

    CAS  PubMed  Google Scholar 

  98. Imperial ES, Levy MN, Zieske H. Outflow resistance as an independent determinant of cardiac performance. Circ Res. 1961;9:1148–55.

    Google Scholar 

  99. Sonnenblick EH, Downing SE. Afterload as a primary determinant of ventricular performance. Am J Physiol. 1963;204:604–10.

    CAS  PubMed  Google Scholar 

  100. Cohn JN. Vasodilator therapy for heart failure: the influence of impedance on left ventricular performance. Circulation. 1973;48:5–8.

    CAS  PubMed  Google Scholar 

  101. Cohn JN, Franciosa JA. Vasodilator therapy of cardiac failure. N Engl J Med 1977; 297:27–31, 254–8

    Google Scholar 

  102. Franciosa JA, Limas CJ, Guiha NH, Rodriguera E, Cohn JN. Improved left ventricular function during nitroprusside infusion in acute myocardial infarction. Lancet. 1972;1:650–4.

    CAS  PubMed  Google Scholar 

  103. Franciosa JA, Nordstrom LA, Cohn JN. Nitrate therapy for congestive heart failure. JAMA. 1978;240:443–6.

    CAS  PubMed  Google Scholar 

  104. Palmer RMG, Ferrige AG, Moncada S. Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor. Nature. 1987;327:524–6.

    CAS  PubMed  Google Scholar 

  105. Kubo SH, Rector TS, Bank AJ, et al. Endothelium-dependent vasodilation is attenuated in patients with heart failure. Circulation. 1991;84:1589–96.

    CAS  PubMed  Google Scholar 

  106. Cohn JN. Principles of vasodilator therapy in congestive heart failure: impact on mortality. In: Singh BN, Dzau VJ, Vanhoutte PM, Woosley RL, editors. Cardiovascular Pharmacology and Therapeutics. New York, NY: Churchill Livingstone; 1994. p. 791–6.

    Google Scholar 

  107. Majure DT, Teerlink JR. Update on the management of acute decompensated heart failure. Curr Treat Options Cardiovasc Med. 2011;13(6):570–85.

    Google Scholar 

  108. Senni M, Tribouilloy CM, Rodeheffer RJ, et al. Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation. 1998;98:2282–9.

    CAS  PubMed  Google Scholar 

  109. Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996;275:1557–62.

    CAS  PubMed  Google Scholar 

  110. Shih H, Lee B, Lee RJ, Boyle AJ. The aging heart and post-infarction left ventricular remodeling. J Am Coll Cardiol. 2011;57:9–17.

    PubMed  Google Scholar 

  111. Jugdutt BI, Becker LC, Hutchins GM, et al. Effect of intravenous nitroglycerin on collateral blood flow and infarct size in the conscious dog. Circulation. 1981;63:17–28.

    CAS  PubMed  Google Scholar 

  112. Jugdutt BI. Myocardial salvage by intravenous nitroglycerin in conscious dogs: loss of beneficial effect with marked nitroglycerin-induced hypotension. Circulation. 1983;68:673–84.

    CAS  PubMed  Google Scholar 

  113. Jugdutt BI. Intravenous nitroglycerin unloading in acute myocardial infarction. Am J Cardiol. 1991;68:52D–63D.

    CAS  PubMed  Google Scholar 

  114. Cheng JW, Nayar M. A review of heart failure management in the elderly population. Am J Geriatr Pharmacother. 2009;7:233–49.

    CAS  PubMed  Google Scholar 

  115. Franciosa JA, Pierpont GL, Cohn JN. Hemodynamic improvement after oral hydralazine in left ventricular failure: a comparison with nitroprusside infusion. Ann Intern Med. 1977;86:388–93.

    CAS  PubMed  Google Scholar 

  116. Franciosa JA, Mikulic E, Cohn JN, et al. Hemodynamic effects of orally administered isosorbide dinitrate in patients with congestive heart failure. Circulation. 1974;50:1020–4.

    CAS  PubMed  Google Scholar 

  117. Pierpont GL, Cohn JN, Franciosa JA. Combined oral hydralazine-nitrate therapy in left ventricular failure. Hemodynamic equivalency to sodium nitroprusside. Chest. 1978;73:8–13.

    CAS  PubMed  Google Scholar 

  118. Massie B, Chatterjee K, Werner J, et al. Hemodynamic advantage of combined administration of hydralazine orally and nitrates nonparenterally in the vasodilator therapy of chronic heart failure. Am J Cardiol. 1977;40:794–801.

    CAS  PubMed  Google Scholar 

  119. Chatterjee K, Viquerat CE, Daly P. Neurohumoral abnormalities in heart failure. Heart Fail. 1985;1:69–85.

    Google Scholar 

  120. Cohn JN, Archibald DG, Ziesche S, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans administration Cooperative study (V-HeFT). N Engl J Med. 1986;314:1547–52.

    CAS  PubMed  Google Scholar 

  121. 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;325:303–10.

    CAS  PubMed  Google Scholar 

  122. Cohn JN, et al. The management of chronic heart failure. N Engl J Med. 1996;335:490–8.

    CAS  PubMed  Google Scholar 

  123. Cole RT, Kalogeropoulos P, Georgiopoulos VV, et al. Hydralazine and isosorbide dinitrate in heart failure: historical perspective, mechanisms and future directions. Circulation. 2011;123:2414–22.

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  125. Jugdutt BI. Nitrates as anti-ischemic and cardioprotective agents. In: Singh BN, Dzau VJ, Vanhoutte PM, Woosley RL, editors. Cardiovascular Pharmacology and Therapeutics. New York, NY: Churchill Livingstone; 1994. p. 449–65.

    Google Scholar 

  126. Jugdutt BI, Warnica JW. Intravenous nitroglycerin therapy to limit myocardial infarct size, expansion and complications: effect of timing, dosage and infarct location. Circulation. 1988;78:906–19.

    CAS  PubMed  Google Scholar 

  127. Publication Committee for the VMAC Investigators (Vasodilatation in the Management of Acute CHF) Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial (2002). JAMA 2002;287:1531–40

    Google Scholar 

  128. Sackner-Bernstein JD, Kowalski M, Fox M, Aaronson K. Short-term risk of death after treatment with nesiritide for decompensated heart failure: a pooled analysis of randomized controlled trials. JAMA. 2005;293:1900–5.

    CAS  PubMed  Google Scholar 

  129. Sackner-Bernstein JD, Skopicki HA, Aaronson KD. Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation. 2005;111(12):1487–91.

    CAS  PubMed  Google Scholar 

  130. O’Connor CM, Starling RC, Hernandez AF, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365:32–43.

    PubMed  Google Scholar 

  131. McMurray JJV, Pitt B, Latini R, et al. Effects of the oral renin inhibitor aliskerin in patients with symptomatic HF. Circ Heart Fail. 2008;1:17–24.

    CAS  PubMed  Google Scholar 

  132. Gheorghiade M, Albaghdadi M, Zannad F, ASTRONAUT Investigators and Study Coordinators, et al. Rationale and design of the multicentre, randomized, double-blind, placebo-controlled aliskiren trial on acute heart failure outcomes (ASTRONAUT). Eur J Heart Fail. 2011;13:100–6.

    CAS  PubMed  Google Scholar 

  133. Krum H, Massie B, Abraham WT, ATMOSPHERE Investigators, et al. Direct renin inhibition in addition to or as an alternative to angiotensin converting enzyme inhibition in patients with chronic systolic heart failure: rationale and design of the aliskiren trial to minimize outcomes in patients with heart failure (ATMOSPHERE) study. Eur J Heart Fail. 2011;13:107–14.

    CAS  PubMed  Google Scholar 

  134. Solomon SD, Shin SH, Shah A, Aliskiren Study in Post-MI Patients to Reduce Remodeling (ASPIRE) Investigators, et al. Effect of the direct renin inhibitor aliskiren on left ventricular remodelling following myocardial infarction with systolic dysfunction. Eur Heart J. 2011;32:1227–34.

    CAS  PubMed  Google Scholar 

  135. Rasilez® ASPIRE HIGHER. Clinical program expands to 35,000 patients in 14 trials, the largest cardio-renal outcomes program ever. Medical News Today (MNT). 2008. http://www.medicalnewstoday.com/releases/112086.php. Last Accessed on 26 Aug 2013.

  136. Parving HH, Persson F, Lewis JB, AVOID Study Investigators, et al. Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med. 2008;358:2433–46.

    CAS  PubMed  Google Scholar 

  137. Parving HH, Brenner BM, McMurray JJ, ALTITUDE Investigators, et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med. 2012;367:2204–22.

    CAS  PubMed  Google Scholar 

  138. Solomon SD, Skali H, Bourgoun M, OVERTURE Investigators, et al. Effect of angiotensin-converting enzyme or vasopeptidase inhibition on ventricular size and function in patients with heart failure: The omapatrilat versus enalapril randomized trial of utility in reducing events (OVERTURE) echocardiographic study. Am Heart J. 2005;150:257–62.

    CAS  PubMed  Google Scholar 

  139. Solomon SD, Zile M, Pieske B, PARAMOUNT Investigators, et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomized clinical trial. Lancet. 2012;380(9851):1387–95.

    CAS  PubMed  Google Scholar 

  140. ClinicalTrials.gov. Prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in patients with heart failure (PARADIGM-HF). 2012. http://ClinicalTrials.gov/ct2//show/NCT01035255. Last Accessed Aug 2012.

    Google Scholar 

Download references

Acknowledgements

This work was supported in part by grant # IAP99003 from the Canadian Institutes of Health Research, Ottawa, Ontario. I am indebted to Catherine Jugdutt for the assistance.

Author information

Authors and Affiliations

  1. 2C2 W.C. Mackenzie Health Sciences Centre, Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta and Hospitals, 8440-112 Street, Edmonton, AB, Canada, T6G 2B7

    Bodh I. Jugdutt MD, MSc, DM, FRCPC

  2. Department of Medicine, Section of Cardiology, King Abdulaziz Hospital, Alhasa, Saudi Arabia

    Anwar Jelani MBBS, SBIM, FACC

  3. Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Seraj Abualnaja MDDS, FRCPC

  4. Division of Cardiology, Department of Medicine, Mazankowski Heart Institute, WMC 2C2 8440-112 Street, Edmonton, AB, Canada, T6B 287

    Nakul Chander Sharma MD, FRCP

  5. Division of Cardiology, Department of Medicine, University of Alberta Hospital, 2C2, WMC, 727, Todd Landing NW, Edmonton, AB, Canada, T6G 2B7

    Joseph Szeman Wong MBBS, MRCP, FHKCP, FRCPC

Authors
  1. Bodh I. Jugdutt MD, MSc, DM, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anwar Jelani MBBS, SBIM, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seraj Abualnaja MDDS, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nakul Chander Sharma MD, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joseph Szeman Wong MBBS, MRCP, FHKCP, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bodh I. Jugdutt MD, MSc, DM, FRCPC .

Editor information

Editors and Affiliations

  1. Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta and Hospitals, Edmonton, Alberta, Canada

    Bodh I. Jugdutt

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Jugdutt, B.I., Jelani, A., Abualnaja, S., Sharma, N.C., Wong, J.S. (2014). Reperfusion and Vasodilator Therapy in Elderly Patients with STEMI and Heart Failure: Improving Outcomes. In: Jugdutt, B. (eds) Aging and Heart Failure. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0268-2_14

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0268-2_14

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-0267-5

  • Online ISBN: 978-1-4939-0268-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation