Skip to main content
SpringerLink
Log in

Optimizing Therapy of Heart Failure in the Aging Population with Monitoring in Clinics

  • Chapter
  • First Online:
Aging and Heart Failure

  • 1712 Accesses

Abstract

In recent years, the incidence and prevalence of heart failure (HF) has risen to epidemic proportions and has a direct correlation with aging; HF affects <1 % of adults under 50 years of age, but in patients over 80, the prevalence exceeds 10 %. Optimizing heart failure therapy in clinics under the guidance of multidisciplinary management teams has been shown to reduce readmission rates and mortality. Several contemporary randomized trials have shown up to 50 % fewer hospital readmissions with multidisciplinary HF intervention teams versus usual care whoever in the aging population poses unique challenges in management. A multidisciplinary approach and a thorough understanding of cardiology, geriatrics, and internal medicine are necessary. An important consideration often overlooked by healthcare professionals is that heart failure interventions may further contribute to patient frailty and complicate management. In this chapter we discuss the options and considerations for managing elderly patients with heart failure.

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. Hauptman PJ, Rich MW, Heidenreich PA, Chin J, Cummings N, Dunlap ME, et al. The heart failure clinic: a consensus statement of the Heart Failure Society of America. J Card Fail. 2008;14:801–15.

    Article  PubMed  Google Scholar 

  2. Ezekowitz JA, Kaul P, Bakal JA, Quan H, McAlister FA. Trends in heart failure care: has the incident diagnosis of heart failure shifted from the hospital to the emergency department and outpatient clinics? Eur J Heart Fail. 2011;13(2):142–7.

    Article  PubMed  Google Scholar 

  3. Arnold JMO, Liu P, Demers C, Dorian P, Giannetti N, Haddad H, et al. Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: diagnosis and management. Can J Cardiol. 2006;22:23–45.

    Article  PubMed  Google Scholar 

  4. 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(4):430–5.

    PubMed  Google Scholar 

  5. Ezekowitz JA, Bakal JA, Kaul P, Westerhout CM, Armstrong PW. Acute heart failure in the emergency department: short and long-term outcomes of elderly patients with heart failure. Eur J Heart Fail. 2008;10(3):308–14.

    Article  PubMed  Google Scholar 

  6. Rich MW. Heart failure in the elderly: strategies to optimize outpatient control and reduce hospitalizations. Am J Geriatr Cardiol. 2003;12(1):19–24.

    Article  PubMed  Google Scholar 

  7. McAlister FA, Teo KK, Taher M, Montague TJ, Humen D, Cheung L, et al. Insights into the contemporary epidemiology and outpatient management of congestive heart failure. Am Heart J. 1999;138(1 Pt 1):87–94.

    Article  CAS  PubMed  Google Scholar 

  8. McAlister FA, Lawson FM, Teo KK, Armstrong PW. A systematic review of randomized trials of disease management programs in heart failure. Am J Med. 2001;110(5):378–84.

    Article  CAS  PubMed  Google Scholar 

  9. Howlett JG, McKelvie RS, Costigan J, Ducharme A, Estrella-Holder E, Ezekowitz JA, et al. The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs. Can J Cardiol. 2010;26:185–202.

    Article  PubMed  Google Scholar 

  10. McAlister FA, Ezekowitz J, Hooton N, Vandermeer B, Spooner C, Dryden DM, et al. Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction. JAMA. 2007;297(22):2502–14.

    Article  CAS  PubMed  Google Scholar 

  11. Ezekowitz JA, Rowe BH, Dryden DM, Hooton N, Vandermeer B, Spooner C, et al. Systematic review: implantable cardioverter defibrillators for adults with left ventricular systolic dysfunction. Ann Intern Med. 2007;147(4):251–62.

    Article  PubMed  Google Scholar 

  12. Al-Majed NS, McAlister FA, Bakal JA, Ezekowitz JA. Meta-analysis: cardiac resynchronization therapy for patients with less symptomatic heart failure. Ann Intern Med. 2011;154(6):401–12.

    Article  PubMed  Google Scholar 

  13. Jarrett PG, Rockwood K, Carver D, Stolee P, Cosway S. Illness presentation in elderly patients. Arch Intern Med. 1995;155(10):1060–4.

    Article  CAS  PubMed  Google Scholar 

  14. Tresch DD. The clinical diagnosis of heart failure in older patients. J Am Geriatr Soc. 1997;45(9):1128–33.

    CAS  PubMed  Google Scholar 

  15. Bergan JJ, Schmid-Schönbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med. 2006;355(5):488–98.

    Google Scholar 

  16. Pedersen F, Mehlsen J, Raymond I, Atar D, Skjoldborg US, Hildebrandt PR. Evaluation of dyspnoea in a sample of elderly subjects recruited from general practice. Int J Clin Pract. 2007;61(9):1481–91.

    Article  CAS  PubMed  Google Scholar 

  17. von Haehling S, Morley JE, Anker SD. An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle. 2010;1(2):129–33.

    Article  Google Scholar 

  18. Oreopoulos A, Kalantar-Zadeh K, McAlister FA, Ezekowitz JA, Fonarow GC, Johnson JA, et al. Comparison of direct body composition assessment methods in patients with chronic heart failure. J Card Fail. 2010;16(11):867–72.

    Article  PubMed  Google Scholar 

  19. Cacciatore F, Abete P, Ferrara N, Calabrese C, Napoli C, Maggi S, et al. Congestive heart failure and cognitive impairment in an older population. Osservatorio Geriatrico Campano Study Group. J Am Geriatr Soc. 1998;46(11):1343–8.

    CAS  PubMed  Google Scholar 

  20. Vogels RLC, Oosterman JM, van Harten B, Scheltens P, van der Flier WM, Schroeder-Tanka JM, et al. Profile of cognitive impairment in chronic heart failure. J Am Geriatr Soc. 2007;55(11):1764–70.

    Article  PubMed  Google Scholar 

  21. Qiu C, Winblad B, Marengoni A, Klarin I, Fastbom J, Fratiglioni L. Heart failure and risk of dementia and Alzheimer disease: a population-based cohort study. Arch Intern Med. 2006;166(9):1003–8.

    Article  PubMed  Google Scholar 

  22. Heart Failure Society of America, Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010;16:e1–194.

    Article  PubMed  Google Scholar 

  23. Authors/Task Force Members, McMurray JJV, Adamopoulos S, Anker SD, Auricchio A, Böhm M, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847.

    Article  PubMed  Google Scholar 

  24. Tjam EY, Heckman GA, Smith S, Arai B, Hirdes J, Poss J, et al. Predicting heart failure mortality in frail seniors: comparing the NYHA functional classification with the Resident Assessment Instrument (RAI) 2.0. Int J Cardiol. 2012;155(1):75–80.

    Article  PubMed  Google Scholar 

  25. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.

    Article  PubMed  Google Scholar 

  26. McKelvie RS, Moe GW, Cheung A, Costigan J, Ducharme A, Estrella-Holder E, et al. The 2011 Canadian Cardiovascular Society heart failure management guidelines update: focus on sleep apnea, renal dysfunction, mechanical circulatory support, and palliative care. Can J Cardiol. 2011;27(3):319–38.

    Article  PubMed  Google Scholar 

  27. Arnold JMO, Howlett JG, Dorian P, Ducharme A, Giannetti N, Haddad H, et al. Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: prevention, management during intercurrent illness or acute decompensation, and use of biomarkers. Can J Cardiol. 2007;23:21–45.

    Article  CAS  PubMed  Google Scholar 

  28. Wang TJ, Larson MG, Levy D, Leip EP, Benjamin EJ, Wilson PWF, et al. Impact of age and sex on plasma natriuretic peptide levels in healthy adults. Am J Cardiol. 2002;90(3):254–8.

    Article  CAS  PubMed  Google Scholar 

  29. Redfield MM, Rodeheffer RJ, Jacobsen SJ, Mahoney DW, Bailey KR, Burnett Jr JC. Plasma brain natriuretic peptide concentration: impact of age and gender. J Am Coll Cardiol. 2002;40(5):976–82.

    Article  CAS  PubMed  Google Scholar 

  30. Felker GM, Hasselblad V, Hernandez AF, O’Connor CM. Biomarker-guided therapy in chronic heart failure: a meta-analysis of randomized controlled trials. Am Heart J. 2009;158(3):422–30.

    Article  CAS  PubMed  Google Scholar 

  31. Pfisterer M, Buser P, Rickli H, Gutmann M, Erne P, Rickenbacher P, et al. BNP-guided vs symptom-guided heart failure therapy: the trial of intensified vs standard medical therapy in elderly patients with congestive heart failure (TIME-CHF) randomized trial. JAMA. 2009;301(4):383–92.

    Article  CAS  PubMed  Google Scholar 

  32. Maeder MT, Rickli H, Pfisterer ME, Muzzarelli S, Ammann P, Fehr T, 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. 414.e1.

    Article  PubMed  Google Scholar 

  33. Tonkin AL, Wing LM. Effects of age and isolated systolic hypertension on cardiovascular reflexes. J Hypertens. 1994;12(9):1083–8.

    Article  CAS  PubMed  Google Scholar 

  34. Cléroux J, Giannattasio C, Grassi G, Seravalle G, Sampieri L, Cuspidi C, et al. Effects of ageing on the cardiopulmonary receptor reflex in normotensive humans. J Hypertens Suppl. 1988;6(4):S141–4.

    Article  PubMed  Google Scholar 

  35. Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative group on ACE inhibitor trials. JAMA. 1995;273(18):1450–6.

    Article  CAS  PubMed  Google Scholar 

  36. Foody JM, Farrell MH, Krumholz HM. beta-Blocker therapy in heart failure: scientific review. JAMA. 2002;287(7):883–9.

    Article  CAS  PubMed  Google Scholar 

  37. Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJV. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail. 2009;11(2):130–9.

    Article  PubMed  Google Scholar 

  38. Muzzarelli S, Maeder MT, Toggweiler S, Rickli H, Nietlispach F, Julius B, 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  CAS  PubMed  Google Scholar 

  39. Zannad F, McMurray JJV, Krum H, Van Veldhuisen DJ, Swedberg K, Shi H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11–21.

    Article  CAS  PubMed  Google Scholar 

  40. Muzzarelli S, Tobler D, Leibundgut G, Schindler R, Buser P, Pfisterer ME, et al. Detection of intake of nonsteroidal anti-inflammatory drugs in elderly patients with heart failure. How to ask the patient? Swiss Med Wkly. 2009;139(33–34):481–5.

    CAS  PubMed  Google Scholar 

  41. Healey JS, Hallstrom AP, Kuck K-H, Nair G, Schron EP, Roberts RS, et al. Role of the implantable defibrillator among elderly patients with a history of life-threatening ventricular arrhythmias. Eur Heart J. 2007;28(14):1746–9.

    Article  PubMed  Google Scholar 

  42. Lee DS, Tu JV, Austin PC, Dorian P, Yee R, Chong A, et al. Effect of cardiac and noncardiac conditions on survival after defibrillator implantation. J Am Coll Cardiol. 2007;49(25):2408–15.

    Article  PubMed  Google Scholar 

  43. Cleland J, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539–49.

    Article  CAS  PubMed  Google Scholar 

  44. Arcand J, Ivanov J, Sasson A, Floras V, Al-Hesayen A, Azevedo ER, et al. A high-sodium diet is associated with acute decompensated heart failure in ambulatory heart failure patients: a prospective follow-up study. Am J Clin Nutr. 2011;93(2):332–7.

    Article  CAS  PubMed  Google Scholar 

  45. Arcand JAL, Brazel S, Joliffe C, Choleva M, Berkoff F, Allard JP, et al. Education by a dietitian in patients with heart failure results in improved adherence with a sodium-restricted diet: a randomized trial. Am Heart J. 2005;150(4):716.

    Article  PubMed  Google Scholar 

  46. Brunner-La Rocca HP, Rickenbacher P, Muzzarelli S, Schindler R, Maeder MT, Jeker U, et al. End-of-life preferences of elderly patients with chronic heart failure. Eur Heart J. 2012;33(6):752–9.

    Article  PubMed  Google Scholar 

  47. Thai V, Ezekowitz JA, Cujec B. A call to action: cardiac palliative care. J Palliat Med. 2009;12(4):289–90.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

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

    John R. Dimitry MD, MPH, FRCPC

  2. Division of Cardiology, Department of Medicine, University of Alberta, 8440-112 Street, Edmonton, AB, Canada, T6G 2B7

    Justin A. Ezekowitz MBBCh, MSc

Authors
  1. John R. Dimitry MD, MPH, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Justin A. Ezekowitz MBBCh, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Justin A. Ezekowitz MBBCh, MSc .

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

Dimitry, J.R., Ezekowitz, J.A. (2014). Optimizing Therapy of Heart Failure in the Aging Population with Monitoring in Clinics. In: Jugdutt, B. (eds) Aging and Heart Failure. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0268-2_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0268-2_6

  • 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