Interní Med. 2008; 10(5): 212-215

Heart failure in elderly

prof. MUDr. Lenka Špinarová Ph.D., FESC, prof. MUDr. Jindřich Špinar CSc., FESC, prof. MUDr. Jiří Vítovec CSc

I. interní kardioangiologická klinika FN u sv. Anny v Brně

The goal of chronic heart failure (CHF) treatment is to increase a quality of life, i. e. decrease or completely remove symptoms, increase the exercise tolerance, decrease mortality and prolong patient’s life. Elderly patients have various priorities and in most of questionnaires in patient 70 year old and older the quality of life is placed on the first place. The basic treatment of patients with CHF regardless the age are medications with evidence about the increase of quality of life and decrease of mortality. These medications are ACE-inhibitors and/or AII antagonists and betablockers. Subgroup analyses show that the effect of RAS blockade is age independent. There is a trend to lower use of ACE inhibitors and significantly lower use of betablockers in older population. On the other hand loop diuretics and digoxin are used more frequently. A detailed analysis showed that elderly patients receive significantly lower doses of ACE-inhibitors and betablockers. The study SENIOR with the goal to evaluate the efficacy of nebivolol on morbidity and mortality of older patients targeted older patients with CHSS regardless the ejection fraction. There are no separate guidelines for the treatment of diastolic heart failure. The study PEP-CHF followed older population with diastolic heart failure treated with perindopril. The most important is good control of blood pressure (< 140/90 mmHg) and heart rate (60–80/min). From antihypertensive medications we prefer betablockers, ACE-inhibitors and AII antagonist, in cases with fluid retention diuretics are the treatment of choice. Positive inotropic agents are not indicated.

Keywords: heart failure, older population, treatment

Published: June 1, 2008  Show citation