Drug therapy in elderly heart failure patients

Abstract

Although heart failure (HF) is considered as a cardiogeriatric syndrome, elderly and very elderly patients are under-represented in the vast majority of clinical trials investigating novel drugs and therapies in this population. The homoeostatic systems of elderly subjects are very fragile, and the management of HF accompanied by numerous comorbidities requires a holistic approach towards the patient, with special emphasis not only on psychosomatic problems but also on the individual (including social) needs of each particular patient, along with the support for the family and/or caregivers. In this article, we summarize current evidence regarding pharmacotherapy of elderly patients with HF and summarize the clinical problems occurring in this population.

A patient with heart failure, who is frail: How does this affect therapeutic decisions?

“…To this end, a thorough clinical assessment should be carried out to differentiate frailty from multimorbidity [31]. -The presence of asymptomatic/subclinical, age-related coexisting diseases should be assessed and optimized [10]. -It should be borne in mind that multimorbidity may complicate the interpretation of symptoms of HF and vice versa [36].…”

“…-It is worth carrying out the screening assessment for the most common somatic diseases, often asymptomatic (diabetes mellitus, hypertension, renal failure, anemia, iron deficiency, thyroid dysfunction) and implement optimal treatment as required [1]. -Screening for dementia and symptoms indicating depression is worthwhile and optimal treatment should be implemented where applicable [10,38]. -When making therapeutic decisions, it should be remembered that cognitive dysfunction and depression adversely affect the adherence to therapeutic recommendations in HF [39].…”

“…Aim to minimize polypharmacy by prioritizing those interventions that improve quality of life. When selecting drugs and adjusting their doses, consideration should be given to factors affecting pharmacokinetics and pharmacodynamics, such as kidney dysfunction, liver dysfunction, hypoalbuminemia, catabolic state, hypovolaemia -common in frail subjects [10,29,[41][42][43].…”

“…-Patients undergoing diuretic treatment should be particularly monitored for hypovolemia, hyponatremia and hypokalemia as they may lead to pre-renal kidney failure, delirium, and orthostatic hypotension [10]. -Moreover, attention should be paid to patients with hypoalbuminemia whose pharmacokinetics may be impaired, including diuretic treatment with furosemide may be less effective [44].…”

“…-Moreover, attention should be paid to patients with hypoalbuminemia whose pharmacokinetics may be impaired, including diuretic treatment with furosemide may be less effective [44]. -Priority should be given to drugs included in European recommendations and with proven efficacy and safety for HF patients with frailty and multimorbidity [10]. It should be stressed that new groups of drugs also have their place in older patients with HF and/or FS.…”