Incidence and prevalence of the heart failure is ...



CHF in Older Adults

• The incidence and prevalence of the heart failure is strikingly age-dependent: It is uncommon in individuals less than 45years old, doubles each decade thereafter and approaches 10% in adults over 80 years of age.

• CHF is currently the leading indication for hospitalization in individuals over 65 years of age. Heart failure ranks second to hypertension among cardiovascular causes for outpatient visits.

• The changes associated with cardiovascular aging result in a reduced ability of the heart to respond to stress, whether physiological or pathological; increased vascular stiffness; alterations in cardiac relaxation and stiffness, and altered myocardial energy metabolism at the level of mitochondria.

• The etiology of heart failure is multifactorial in older patients compared to younger adults. HTN and CAD are the most common causes of CHF in 70% of cases. Heart failure in older patients is often precipitated by acute or worsening non-cardiac conditions, such as pneumonia, pulmonary embolism, COPD exacerbations and pyelonephritis.

• While the most common symptoms of CHF in older adults are exertional dyspnea, orthopnea, fatigue, dependent edema and exercise intolerance.Atypical symptomatology in those over 80 years old is common and include nonspecific systemic complaints, confusion, irritability, sleep disturbances and gastrointestinal disorders, such as anorexia, abdominal discomfort, nausea and diarrhea.

• Physical findings may be atypical and nonspecific like impaired sensorium and Cheyne Stokes respirations.

• Optimal therapy in older patients comprise three principle components; correction of underlying etiology whenever possible, attention to non-pharmacological and rehabilitative aspects of treatment and judicious use of medications.

• In older heart failure patients, drugs should be started at lower doses and gradually increased (e.g., captopril 6.25- 12.5 mg tid- qid or enalapril 2.5-5 mg bid).

• Due to age-related changes in renal function and a higher prevalence of comorbid illnesses, elders are at increased risk for serious diuretic–induced electrolyte abnormalities; hence, electrolytes should be monitored closely when diuretic therapy is adjusted.

• Therapeutic range for digoxin is lower in older patients: A serum digoxin concentration of 0.5 to 1.5 ng/ml is appropriate.

• In elderly patients, prognosis is typically worse than that of younger patients: Only 20% survive more than 5 years.

References

1.J.Cardiology clinics vol17,no.1,Feb 1999

2.J.of American Geriatric society 1997,Aug.45 (8):968-74

3.Princples of Geriatrics : Hazzard, Textbook

Supported by a grant from the Association of American Medical Colleges and the John A. Hartford Foundation.

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