Treatment for chronic heart failure in the elderly: current practice and problems

• Published in: Heart failure reviews Vol. 18; no. 4; pp. 529 - 551
• Main Authors: Abete, Pasquale, Testa, Gianluca, Della-Morte, David, Gargiulo, Gaetano, Galizia, Gianluigi, de Santis, Domenico, Magliocca, Antonio, Basile, Claudia, Cacciatore, Francesco
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-07-2013; Springer Nature B.V
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Body Mass Index; Cardiology; Chronic Disease; Drug Therapy, Combination; Evidence-Based Medicine; Heart Failure - drug therapy; Heart Failure - etiology; Heart Failure - physiopathology; Heart Failure - therapy; Humans; Medication Adherence; Medicine; Medicine & Public Health; Obesity - complications; Palliative Care - methods; Practice Guidelines as Topic; Risk Factors; Self Care; Treatment Outcome; Weight Loss; Adherence; Therapy; Chronic heart failure; Comorbidity
• ISSN: 1382-4147; 1573-7322
• DOI: 10.1007/s10741-012-9363-6

Treatment for chronic heart failure (CHF) is strongly focused on evidence-based medicine. However, large trials are often far away from the “real world” of geriatric patients and their messages are poorly transferable to the clinical management of CHF elderly patients. Precipitating factors and especially non-cardiac comorbidity may decompensate CHF in the elderly. More importantly, drugs of first choice, such as angiotensin-converting enzyme inhibitors and β-blockers, are still underused and effective drugs on diastolic dysfunction are not available. Poor adherence to therapy, especially for cognitive and depression disorders, worsens the management. Electrical therapy is indicated, but attention to the older age groups with reduced life expectancy has to be paid. Physical exercise, stem cells, gene delivery, and new devices are encouraging, but definitive results are still not available. Palliative care plays a key role to the end-stage of the disease. Follow-up of CHF elderly patient is very important but tele-medicine is the future. Finally, self-care management, caregiver training, and multidimensional team represent the critical point of the treatment for CHF elderly patients.