-
Views
-
Cite
Cite
Marco Metra, Livio Dei Cas, Barry M. Massie, Treatment of heart failure in the elderly: never say it's too late, European Heart Journal, Volume 30, Issue 4, February 2009, Pages 391–393, https://doi.org/10.1093/eurheartj/ehp024
Close - Share Icon Share
Extract
Komajda et al. have provided very important information on an essential and relatively unstudied group of heart failure (HF) patients—those 80 years of age and older.1 Their findings from the Euro Heart Failure Survey (EHFS) II provide unique information on the characteristics and outcomes in this group and secular trends in their management. In this editorial, we will try to place their findings in the broader context of HF management, highlighting what is known and, more importantly, what is not known about this patient group.
The background: heart failure as a disease of the elderly
HF is predominantly a disease of the elderly. The mean age of HF patients is >70 years in most developed countries, and the prevalence of HF rises dramatically with age, from 1–2% among individuals aged 45–54 years to >10% among those aged ≥75 years.2 Ageing predisposes to HF through multiple mechanisms. First, HF is a frequent outcome of virtually all cardiovascular diseases. Hence, patients with most cardiovascular diseases (i.e. hypertension, acute coronary syndromes, cardiac surgery, etc.) are prone to developing ventricular remodelling and HF when elderly. Secondly, even in the absence of any cardiovascular event, ageing is associated with reduced aortic and left ventricular (LV) compliance, with increased aortic impedance and abnormal LV diastolic function. These conditions lower the threshold for the development of HF when the heart is exposed to precipitating factors such as hypertension and/or tachyarrhythmias (especially atrial fibrillation).
