Epidemiology and Prognosis of Heart Failure

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.

“…Comorbidities and mortality in HF both increase with age 3 , 4 . The typical pathophysiology of HF changes as we look at older patient populations.…”

Section: The Effects Of Agementioning

confidence: 99%

Ageing, demographics, and heart failure

Coats

2019

“…Heart failure (HF) and the comorbidities that accumulate in the HF patient are disorders of the elderly 1 with mortality and morbidity steeply increasing with age 2 . Younger HF patients have the type of HF that was studied in the major trials that proved the benefit of angiotensin-converting enzyme inhibitors beta-blockers and MRA’s.…”

Section: Epidemiology and The Effects Of Agementioning

confidence: 99%

Heart failure management of the elderly patient: focus on frailty, sarcopaenia, cachexia, and dementia: conclusions

Coats

2019

With the ageing of populations heart failure is becoming more common and more complex. It is affecting ever older patients and the number of prevalent comorbidities is rising. Even as we continue to gain success in large-scale clinical trials with more effective therapies so our patients are becoming more complex. One of the biggest challenges is the effect of age. Frailty, comorbidity, sarcopaenia, cachexia, polypharmacy, and cognitive decline are all challenging our patients as never before and these challenges will be difficult for cash strapped health care systems to manage. For these reasons, the Heart Failure Association brought together a panel of experts to debate and review this complex area, championing the need for us to establish better ways of caring for the patients of the future.

“…Among patients aged over 65 years supervised by general practitioners presenting with exercise dyspnoea, HF would be diagnosed in one-sixth of them 2 . Finally, the mortality of patients with HF increases with age 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

Drug therapy in elderly heart failure patients

Jankowska

Vitale

Uchmanowicz

et al. 2019

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.