Abstract
Heart failure (HF) is a major and growing public health problem with high morbidity and mortality (Ponikowski et al., 2016). It affects 1-2% of the general population in developed countries, and the average age at diagnosis is 76 years. Because of a better management of acute phase and comorbidities, HF incidence is increasing in elderly patients, with a prevalence rising to 10% among people aged 65 years or older (Mozaffarian et al., 2014). Therefore, a substantial number of elderly patients need to be treated. However, because of clinical trial exclusion criteria or coexisting comorbidities, currently recommended therapies are widely based on younger population with a much lower mean age. In this review, we will focus on available pharmacological, electrical, and mechanical therapies, underlining pros, cons, and practical considerations of their use in this specific patient population.
Highlights
Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Ancona, Italy
Because of a better management of acute phase and comorbidities, Heart failure (HF) incidence is increasing in elderly patients, with a prevalence rising to 10% among people aged 65 years or older (Mozaffarian et al, 2014)
While selected studies differed from previous meta-analysis, the authors found a significant improvement in overall survival after Implantable CardioverterDefibrillator (ICD) implant in patients aged ≥ 65 years (HR 0.62; 95% CI 0.49–0.78) and, of lesser magnitude, even in patients aged ≥ 75 years (HR 0.70; 95% CI 0.51–0.97)
Summary
Several issues must be considered in HF elderly patients undergoing pharmacological treatment. Angiotensin receptor blockers (ARBs) should be considered only in patients who are intolerant to ACEIs due to cough, rash, or angioedema [23] In this regard, main results and subsequently subanalyses of the VAL-HeFT [24], the CHARM [23], and other trials [25, 26] showed that increasing age did not influence the effect of ARBs on the outcomes. The EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) demonstrated that empagliflozin, an inhibitor of sodium-glucose cotransporter 2 (SGTL2), significantly reduces the risk of CV deaths, nonfatal myocardial infarction, or nonfatal stroke in subjects with type 2 DM and established CV disease with a greater benefit in those over 65 [36]. Besides a symptomatic benefit derived from diuretic therapy, to date, there is no evidence showing that the use of ACEIs/ARBs, aldosterone antagonist, or betablockers reduced mortality or morbidity in diastolic HF [38]
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