Heart Failure in Older Adults

Abstract

<p class="first" id="P2">Heart failure (HF) is a leading cause of morbidity, hospitalization, and mortality in older adults, and a growing public health problem placing a huge financial burden on the health care system. Many challenges exist in the assessment and management of HF in geriatric patients, who often have co-existing multi-morbid illness, polypharmacy, cognitive impairment, and frailty. These complex ‘geriatric domains’ greatly affect physical and functional status as well as long-term clinical outcomes. Geriatric patients have been under-represented in major HF clinical trials. Nonetheless, available data suggest that guideline-based medical and device therapies improve morbidity and mortality. Non-pharmacological strategies, such as exercise training and dietary interventions, are an active area of research. Targeted geriatric evaluation including functional and cognitive assessment can improve risk stratification and guide management in older HF patients. Clinical trials that enroll multi-morbid older HF patients and evaluate functional status and quality of life in addition to mortality and cardiovascular morbidity should be encouraged to guide management of this age group. </p>