Care plans for the older heart failure patient

Abstract

Heart failure (HF) professionals are managing an older population with multiple, often interconnected comorbidities. The average age of the HF patient has increased substantially and many have a number of comorbidities. For the older HF patient, diligent planning of care has the potential to reduce hospitalization, improve quality of life and mortality; nevertheless, this vital component is often overlooked. Frailty, cachexia, sarcopenia, and cognitive impairment are all common in the older HF patient and require special care considerations. Many older HF patients live for many years with troublesome symptoms that could be better addressed through the incorporation of a palliative approach to care. Effective care plans can help patients maximize their health potential through both lifestyle and pharmacological interventions. However, current evidence remains scarce on what constitutes an optimal plan, therefore further studies are urgently needed. We review the care that could be implemented for the complex older HF patient with comorbidities.

Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure

“…Frailty is a "multidimensional dynamic state, independent of age that makes the individual with CHF more vulnerable to the effect of stressors" [2]. The relation between CHF and frailty is complex: patients with CHF are up to six times more likely to be frail than those without CHF and frail individuals have a higher risk of developing CHF [3].…”

Exploring the prevalence, impact and experience of cardiac cachexia in patients with advanced heart failure and their caregivers: A sequential phased study

“…However, there was evidence for repetition of key themes before data collection ceased. Finally, it should be noted that sarcopenia is also common in the older heart failure patient, along with cachexia and frailty, 50 and there is therefore some possibility of misdiagnosis between these conditions. Whilst difficult to control for, such crossover should have been fairly minimal whilst using criteria from the consensus definition of cachexia 13 – as sarcopenia is primarily associated with age rather than chronic conditions, does not always result in weight loss and is not linked to loss of fat mass (only skeletal muscle mass).…”