Ageing, demographics, and heart failure

Abstract

Heart failure (HF) is a complex clinical syndrome resulting from structural or functional cardiac disorders. In the developed world, HF is primarily a disorder of the elderly. It is one that is accompanied by many non-cardiac comorbidities that affect treatments given, the patient’s response and treatment tolerance and outcomes. Even the pathophysiological mechanisms of HF change as we look at older patient populations. Younger HF patients typically have ischaemic heart disease and HF with reduced ejection fraction (HFrEF), whereas older patients have more hypertension HF with preserved ejection fraction (HFpEF). The prevalence of HF has progressively increased for many years and rises even more steeply with age. The outcomes of older especially HFpEF patients have not progressed as much younger HFrEF cohorts. We need more studies specifically recruiting older HF patients with more comorbidities, to guide real-world practice, and we need more assessment of patient-reported outcomes and quality of life rather than just mortality effects. The management of elderly patients with HF requires a more holistic approach recognizing individual needs and necessary support mechanisms and our future trials need to guide us more in achieving these gains.

Living with Chronic Heart Failure: Exploring Patient, Informal Caregiver, and Healthcare Professional Perceptions

“…To effectively address challenges of the primarily elderly HF population, Coats [19] argues that 'a more holistic approach to recognizing individual needs and necessary support mechanisms' (p. L5) is needed in the management of HF, and more studies should assess patient-reported outcomes. In line with the basic principle of patient-centered care, our study took into account the perspectives of patients with HF and informal caregivers.…”

Management of heart failure: an Italian national survey on fellows/specialists in geriatrics

“…The prevalence of heart failure (HF) increases with age, reaching up to 14% in adults aged 80 years or over [1], and the majority of HF patients are old, affected by multiple diseases, and on polypharmacy [2,3]. Geriatricians are often in charge of the care of these patients [4,5].…”

Prevalence and Prognostic Significance of Pulmonary Function Test Abnormalities in Hospitalized Patients With Acute Decompensated Heart Failure With Preserved and Reduced Ejection Fraction

“…1,2 Generally, the prognosis of HF is poorer with an increasing number of comorbidities. 1, 3 Another feature of aged patients with HF is the higher frequency of HF with preserved ejection fraction (HFpEF), the prognosis of which is as poor as that of HF with reduced EF (HFrEF). 4-6 A specific treatment for HFpEF has not yet been established, with current management limited to diuretics and the treatment of comorbidities.…”