Heart failure in old age

Czech version

Authors: J. Špinar ¹; L. Špinarová ²
Authors‘ workplace: Interní kardiologická klinika LF MU a FN Brno ¹; I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně ²
Published in: Kardiol Rev Int Med 2018, 20(1): 11-15

Overview

Chronic heart failure (HF) occurs in 0.4% of the European population with a significant increase in older age groups (0.2% < 50 years, 2– 5% 50– 80 years, > 10% over 80 years); the percentage of female patients is rising with increasing age. Therefore it is a disease of older age. The average age of patients is around 75 years. Heart failure is the most common cause of hospitalizations in patients over 65 years of age. Heart failure affects a wide range of patients, from those with normal ejection fraction (EF), typically defined ≥ 50% (HF with preserved EF – HFpEF) to those with reduced left ventricular EF (LV EF), typically defined as < 40% (HF with reduced EF – HFrEF). Patients with LV EF in the 40–49% range are now newly defined as patients with heart failure with mid-range EF , abbreviated as HFmrEF. The determination of plasma concentrations of natriuretic peptides can be used as a basic diagnostic examination. The negative predictive values are very high and unified for all patients, regardless of age. Neurohumoral antagonists (ACEI, MRA, and beta-blockers) have been shown to prolong the survival of HFrEF patients and are therefore recommended for the treatment of all patients, unless they are contraindicated or intolerant. Unfortunately, the studies conducted with these drugs at the end of the 20^th century and the beginning of the 21^st century included only very few senior citizens, and the average age of patients in these studies is 10 to 15 years lower than the average age of the real population with heart failure. For the same reason, the representation of women is also very low. An integral part of heart failure in senior patients is comorbidity, especially hypertension, diabetes mellitus, or atrial fibrillation.

Key words:
heart failure – senior – ejection fraction – natriuretic peptide

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