Elderly HF Research Articles

Citalopram in the treatment of elderly chronic heart failure combined with depression: A systematic review and meta-analysis.

Depression is an independent factor to predict the hospitalization and mortality in the chronic HF patients. Citalopram is known as an effective drug for depression treatment. Currently, there is no specific recommendation in the HF guidelines for the treatment of psychological comorbidity. In recent years, many studies have shown that the citalopram may be safe in treating of chronic HF with depression. To evaluate the efficacy and safety of the citalopram in the treatment of elderly chronic HF combined with depression. PubMed, EMBASE, Cochrane, Web of Science, CNKI, VIP, CBM, and Wanfang were searched from their inception to May 2022. In the treatment of elderly chronic HF combined with depression, randomized controlled studies of the citalopram were included. Independent screening and extraction of data information were conducted by two researchers, and the quality was assessed by the Cochrane bias risk assessment tool. Review manager 5.4.1 was employed for statistical analysis. The results of meta-analysis prove that the citalopram treatment for depressed patients with chronic HF has a benefit for HAMD-24 (MD: -8.51, 95% CI: -10.15 to -6.88) and LVEF (MD: 2.42, 95% CI: 0.51 to 4.33). Moreover, the score of GDS decreases, and NT-proBNP (MD: -537.78, 95% CI: -718.03 to -357.54) is improved. However, the comparison with the control group indicates that there is no good effect on HAMD-17 (MD: -5.14, 95% CI: -11.60 to 1.32), MADRS (MD: -1.57, 95% CI: -3.47 to 0.32) and LVEDD (MD: -1.45, 95% CI: -3.65 to -0.76). No obvious adverse drug reactions were observed. Citalopram treatment for depressed patients with chronic HF has a positive effect on LVEF and NT-proBNP. It can alleviate HAMD-24 and GDS, but the relative benefits for LVEDD, HAMD-17 and MADRS still need to be verified.Systematic Review Registration: PROSPERO [CRD42021289917].

1251 FRAILTY PREVALENCE AND RISK OF SARCOPENIA IN OLDER HEART FAILURE (HF) INPATIENTS

Abstract Introduction Both frailty and HF are common in the elderly population. Elderly HF patients have an increased risk of frailty and elderly frail patients are at a higher risk of developing HF. Frailty is an independent predictor of mortality in cardiovascular disease. Sarcopenia (defined as decreased muscle mass and muscle strength and/or performance) is also prevalent in HF patients and may progress to cardiac cachexia. HF may induce sarcopenia and sarcopenia may contribute to the poor prognosis of HF. Aims Methods A cross-sectional, retrospective analysis of consecutive patients, 60 years and over, admitted with HF to a UK hospital. Data was manually extracted from anonymized electronic records. The Rockwood Clinical Frailty Scale (CFS) was used for assessment for frailty and the SARC-F tool was used for screening for sarcopenia. Patients with medical history of HF but did not present with decompensated HF were excluded. Also, patients with incomplete data were excluded. The IBM SPSS 28 statistical package was used for statistical analysis. Descriptive statistics and risk estimates were calculated. Results 163 patients were analysed; 82 males and 81 females. The mean age was 81.4 years (SD 9.69). 71.5 % of patients were frail while 28.5 % were non-frail. The risk of sarcopenia was 10.9 times greater in the frail than in the non-frail patients (OR = 10.9; 95% C.I 4.85 – 24.67). There was a lower risk of sarcopenia in male patients than in the female patients (OR =0.45; 95% C.I 0.22 – 0.94). Conclusions Frailty is prevalent in older heart failure inpatients. It significantly increases the risk of sarcopenia in these patients. Women are at higher risk of sarcopenia than men. More research is needed into frailty and sarcopenia in.

Loss of perceived social role, an index of social frailty, is an independent predictor of future adverse events in hospitalized patients with heart failure.

Although the impact of physical frailty on prognosis and the effect of cardiac rehabilitation in HF patients has been well established, data for the prognostic impact of social frailty (SF) in HF patients are limited. In addition, the relative importance of each SF domain in clinical outcomes remains unclear. We aimed to get a new insight into the associations of SF with clinical outcomes in elderly hospitalized HF patients. A single-center, retrospective cohort study was conducted using data from 310 in-hospital HF patients aged ≥ 65 years (mean age of 78 ± 8 years; 49% women). Makizako's five questions, a self-reported questionnaire, were used to define SF. The primary outcome was composite events defined by all-cause death and cardiovascular events. Of the 310 elderly HF patients, 188 patients (61%) had SF. Seventy-five patients (24%) had composite events during a mean follow-up period of 1.93 ± 0.91 years. Kaplan-Meier curves showed that patients with SF had a significantly higher composite event rate than patients without SF. In multivariate Cox regression analyses, SF was independently associated with a higher composite event rate after adjusting for prognostic markers [adjusted hazard ratio (HR), 2.01; 95% confidence interval (CI), 1.07-3.78; p = 0.04]. Of the 5 questions for defining SF, an answer of yes to the question about not feeling helpful toward friends or family, which indicates loss of perceived social role, was an independent predictor of composite events (adjusted HR, 2.28; 95% CI, 1.36-3.82; p < 0.01). Inclusion of loss of perceived social role into the baseline prognostic model improved both the continuous net reclassification improvement (0.562; 95% CI, 0.298-0.827; p < 0.01) and integrated discrimination improvement (0.031; 95% CI, 0.006-0.056; p = 0.02). Loss of perceived social role is associated with increased adverse event risk and provides additive prognostic information in elderly HF patients.

Prise en charge de l'insuffisance cardiaque chronique chez le sujet âgé fragile après hospitalisation pour décompensation aiguë ; apport d'une cellule de coordination ville-hôpital ; étude GERICCO-78

AimsHeart failure (HF) is the leading cause of hospitalisation in the elderly in France. Early rehospitalisations are common, often through an emergency department. The aim of this study was to assess the impact of a primary care-hospital coordination network, with interventions by coordination nurses (IDEC), on the rehospitalisations after a first hospitalisation for acute decompensation in frail elderly HF patients. MethodsFrom 01/10/2019 to 01/10/2021, 237 patients aged > 75 years with frailty criteria, hospitalised in 8 departments of 5 private or public hospitals in the Yvelines Sud health territory were followed by an IDEC (hospital visit, telephone contacts, home visit(s)) within 3 months of their return home. This prospective observational study analysed the rate of consultations to the emergency room, rehospitalisations (total and for acute HF), and the number of events avoided at 90 days after discharge. ResultsThe mean age of the patients was 87 years, 54% were women, 68% had a left ventricular ejection fraction > 40%, and 70% had atrial fibrillation. Non-cardiac comorbidities were very frequent. At 3-month follow-up, mortality was 9.3% (22/237), only 27 patients (11.3%) consulted the emergency room for acute HF, and the rehospitalisation rate for HF was 19.8%, without difference according to left ventricular ejection fraction. A consultation to the emergency room or a rehospitalisation for heart failure could be avoided for 10% of patients. ConclusionThis study suggests that a primary care-hospital coordination network with dedicated coordination nurses is useful for the management of very elderly frail patients following hospitalisation for heart failure, limiting visits to the emergency room and rehospitalisations.

Neighborhood Matters For Transitional Care and Heart Failure Hospital Readmission

Introduction The social and economic conditions of where people live has been associated with HF hospital readmission. Multidisciplinary transitional care is effective to decrease HF readmission, but the impact of neighborhood disadvantage on transitional care is unknown. Early provider follow-up and nursing care coordination have unique contributions to transitional care and HF outcomes. The purposes of this study were to examine the relationship between early provider follow-up, nursing care coordination, and hospital readmission in a population of older adults with HF, and determine if an interaction exists with neighborhood disadvantage. Hypothesis There is a direct relationship between early provider follow-up and decreased HF readmission and an indirect relationship through nursing care coordination intensity that is moderated by neighborhood disadvantage. Methods A retrospective, correlational design utilized existing data. Data were from medical records and billing databases. Home addresses from index admissions were geocoded to census block groups and linked to the 2015 Area Deprivation Index database. Logistic regression was used to compare patients by readmission and early provider follow-up status. Moderated mediation analysis included ordinary least squares regression, logistic regression, and bootstrap confidence intervals to test the hypothesis. Results Of 1280 subjects, mean (SD) age was 79 (8.66) years, 50.7% were female, and 25.9% were non-white. In multivariable analysis, early provider follow up decreased the odds of readmission (OR 0.70 [CI, 0.50, 0.97], p=.032) and having 2 care coordination contacts increased the odds of readmission (OR 1.67 [1.07, 2.60], p=.024). Neighborhood disadvantage decreased the odds of having an early provider visit (OR 0.67 [0.49, 0.93], p=.015) and having a care coordination contact within 3 days of hospital discharge increased the odds of a provider visit two-fold (OR 2.13 [1.67, 2.72], p Conclusions Neighborhood disadvantage influences participation in transitional care interventions for the elderly HF population. An interventional study that examines the combined effect of care coordination and provider follow-up on HF readmission, using innovative processes to reach the most disadvantaged populations is needed.

Frailty syndrome and rehospitalizations in elderly heart failure patients

BackgroundHeart failure (HF) patients with frailty syndrome (FS) are at higher risk of falling, decreased mobility, ability to perform the basic activities of daily living, frequent hospitalizations, and death.AimsThe purpose of this study was to evaluate the correlations between FS and hospital readmissions, and to assess which factors are associated with rehospitalizations.MethodsThe study included 330 patients with a mean age of 72.1 ± 7.9 years, diagnosed with HF. Frailty was measured using the Polish version of the Tilburg Frailty Indicator (TFI). Demographic, sociodemographic, and clinical data, such as the New York Heart Association (NYHA) functional class, ejection fraction (EF), number of rehospitalizations, and the medications taken, were obtained.ResultsPositive correlation was observed between the number of hospitalizations and FS. In the single-factor correlation analysis, treatment with diuretics, a higher NYHA class, and a lower left ventricular EF were predictors of a higher number of hospitalizations. Additionally, the physical and psychological components of the TFI, as well as the total TFI score, predisposed HF patients to more frequent hospitalizations.DiscussionIt seems that a deterioration of functional capabilities and an increase in symptom severity naturally lead to increased hospitalization frequency in HF. In the own study, regression analysis indicates that high NYHA classes and TFI social component scores are significant predictors of the number of hospitalizations in the studied group.ConclusionsFS is highly prevalent among elderly HF patients. Higher frailty levels in elderly patients are a determinant of more frequent rehospitalizations in HF.

Utility of the SENIORS elderly heart failure risk model applied to the RICA registry of acute heart failure

BackgroundHeart failure (HF) is predominantly a disease of the elderly. Reliable risk stratification would help in the management of this population, but no model has been well evaluated in elderly HF patients in both acute and chronic settings and not being restricted by ejection fraction. To evaluate the utility of the SENIORS risk model, developed from a clinical trial of elderly patients with chronic HF, in an independent cohort (National Spanish Registry: RICA) of elderly acute HF patients. MethodsWe applied the SENIORS risk model to 926 patients in RICA to estimate risk at one year of a) composite outcome of all-cause mortality or cardiovascular hospital admission and b) all-cause mortality. ResultsIn the RICA registry mean age was 78years, mean ejection fraction 51% and 87% were in NYHA II and III. At one year death/CV hospitalization occurred in 31.9% and all-cause mortality in 19.5%. The risk model provided good separation of Kaplan Meier curves stratified by tertile for death/CV hospitalization and all-cause mortality. The observed versus expected rates of death/CV hospitalization in the lowest, middle and highest risk tertiles were (%) 34/24, 45/41 and 57/67, and for death 13/16, 32/38 and 44/70 respectively. C-statistic for all-cause mortality or CV hospitalization was 0.60 and for all-cause mortality 0.66. ConclusionThe SENIORS risk model was a reliable tool for relative risk stratification among acute heart failure patients in a “real world” registry, but predicted versus observed risk showed some variability. The model provides a useful basis for clinical risk prediction.

Prospective Evaluation of the Association between Depressive Symptoms and Heart Failure Symptom Severity Using Latent Growth Modeling

33% had an ejection fraction $ 45%. Pain was reported by 84% during hospitalization. Despite a trend for decreased pain prevalence, 70% continued to suffer pain 1 month after discharge (Table 1). Pain severity was similar (Table 1). Pain was most frequently associated with degenerative joint disease (48% at baseline, 42% at 1 month) and brought on by physical activity (29% at baseline, 36% at 1 month). No participants associated pain with HF at either measure. Nonsteroidal anti-inflammatory drugs (NSAIDs) were used both before (7%) and after (13%) HF hospitalization. With the exception of usual pain at hospitalization, higher pain ratings tended to be associated with lower KCCQ score (Table 2). An increase in usual pain was associated with lower KCCQ score at 1 month (Rho -0.39; p50.035). Conclusions: In elderly acute HF patients, non-HF related pain remains common following HF hospitalization and is associated with HF-specific health status. In some patients, pain may contribute to decreased functional status and ongoing NSAID use may complicate HF management.

Abstract 9163: Head-to-head Comparison Between the Prognostic Role of Two Functional Tests in a Population of Elderly Patients with Chronic Heart Failure

Background The six-minute walk test (6MWT) and the cardio-pulmonary exercise testing (CPx ) provide a valid assessment of functional performance in patients ( pts ) with HF but in elderly pts a comparison on prognostic validity of the 2 techniques has not been yet performed. Aims: We sought to compare the prognostic ability of the two functional tests in risk stratification of elderly CHF pts. Methods: We prospectively followed-up 170 stable HF outpatients on optimized medical therapy by using a thorough clinical, laboratory and instrumental evaluation, including the 6MWT and the CPX . The composite end-point was death or hospitalizations for cardiovascular causes. Results Mean age was 71±11 years, 28 % were female, 43% had ischemic heart disease, 18 % were in NYHA class III, 70% were on beta-blockers, 13% had an advanced diastolic disfunction, echocardiographic left ventricular ejection fraction ( LVEF ) was 44±13 %, mean BNP was 358±482 pg /ml . The mean distance covered during the 6MWT was 329±104 m. Peak workload was 71±11 watts, peak oxygen consumption (PVO2) was 13.2±4 ml/kg/min, the slope of the regression line relating ventilation to CO2 output, (VE/VCO2 slope) was 34±7 Exercise oscillatory breathing was found in 79 pts (46 %). During a median follow-up of 13 months, 18 patients died of cardiovascular causes and overall 51 met the combined end point of death or cardiovascular hospitalization. Distance walked correlated significantly to PVO2 (r=0.47, p&lt;.0001). By Cox multivariable analysis, independent predictors of outcome were mean distance covered during the 6MWT (HR 0.996, CI 95% 0.992-0.999), LVEF (HR 0.962, CI 95% 0.938 - 0.985) and PVO2 (HR 0.883, CI 95% 0.790-0.987). Conclusions: Among elderly CHF pts 6MWT is not only a simple and reliable first-line test for quantification of exercise intolerance but retains a prognostic value independent of CPX derived PVO2. This is a cornerstone in functional assessment because the 6MWT is widely diffused, safe and may be more feasible than CPX in a population of elderly HF pts.

Abstract P269: Linkage of Patients in a National Heart Failure Clinical Registry to Medicare Claims Data: An Analysis of Generalizability and Longitudinal Outcomes from ADHERE

Background: Registries are increasingly being used to analyze quality, outcomes, and clinical effectiveness in HF patients. The degree to which registry patients reflect the population of real-world HF patients is unclear. Methods: We linked data from the Acute Decompensated Heart Failure National Registry (ADHERE) to Medicare claims. We compared patient characteristics and inpatient mortality of ADHERE hospitalizations linked to Medicare, with ADHERE hospitalizations not linked to Medicare. We also compared patient characteristics, 1-year readmission, inpatient mortality, and 1-year mortality of linked ADHERE patients to a 20% sample of Medicare patients hospitalized for HF. Hospital characteristics among Medicare sites participating and not participating in ADHERE were also compared. Results: Among 135,667 ADHERE hospitalizations for HF patients ≥ 65 years, we linked 104,808 (77.3%) to Medicare claims, representing 82,074 unique patients. Within ADHERE, Medicare-linked hospitalizations were more likely to involve patients who were female and white, but there were no clinically relevant differences in other patient characteristics. In-hospital mortality was identical for ADHERE hospitalizations linked and not linked to Medicare (4.5%). ADHERE hospitals were more likely than non-ADHERE hospitals to be teaching hospitals, to have a higher volume of HF patients, and to offer advanced cardiac care. Within Medicare, ADHERE patients and non-ADHERE patients had similar demographics and comorbidities. ADHERE patients had slightly lower observed mortality and readmission rates (Table). After risk adjustment, modest but statistically significant differences remained. Conclusion: There is a high degree of similarity between ADHERE patients and Medicare patients hospitalized with HF. While there are differences in hospital characteristics, ADHERE data are representative of the real-world elderly HF population. Mortality/readmission outcomes for ADHERE and non-ADHERE Medicare patients hospitalized with HF Outcomes variable Patients within Medicare Non-ADHERE (N=571,649) ADHERE (N=79,508) 1 P-value 2 Adjusted OR/HR (95% CI) 3 Mortality, In-hospital 27,779 (4.9%) 3,516 (4.4%) &lt;.001 0.94 (0.90-0.97) Mortality, 1-year 218,703 (38.3%) 28,579 (36.0%) &lt;.001 0.95 (0.94, 0.96) Readmission, 1-year all-cause 4 349,990 (67.9%) 48,802 (65.8%) &lt;.001 0.94 (0.93, 0.94) Readmission, 1-year cardiovascular 3 223,430 (43.4%) 31,553 (42.6%) &lt;.001 0.96 (0.95, 0.97) 1 Total number of unique, linked ADHERE patients with 1 year prior claims eligible for analysis 2 P-values based on chi-square tests stratified by discharge year 3 In-hospital mortality results shown as odds ratios (OR); all other results shown as hazard ratios (HR) 4 Among patients eligible for readmission analysis (N=518,548 Non-ADHERE patients; N=74,450 ADHERE patients)

078 High prevalence of cognitive disorders in Heart Failure patients: results of the EFICARE survey

Some studies have suggested a high frequency of cognitive disorders in HF patients. To determine the prevalence of cognitive disorders in chronic HF elderly patients. We assessed in an observational study the cognitive function in consecutive HF outpatients followed by French cardiologists. Patients were included if they were aged ≥70 years, had chronic stable HF and have been hospitalized for HF in the last 12 months. Cognitive function was assessed by the largely used MIS (Memory Impairment Screen). Autonomy was assessed by IADL scale (Instrumental Activities of Daily Living). A total of 980 patients were enrolled by 291 cardiologists. Mean age was 79 ± 6 years and 66% were men. Feasibility of MIS was high and the test was performed successfully in 94% of patients by cardiologists. Cognitive disorders were observed in 46% of HF patients. Loss of autonomy was observed in 47% of elderly HF subjects and help by nurses at home was needed in 33% of patients. Patients with cognitive disorders were older (81 years vs 78 years, p<0.001) and more frequently women (41% vs 30%, p = 0.001) than those without cognitive impairment. History of stroke, depression and falls were more prevalent in patients with cognitive disorders (15% vs 10%, p = 0.03; 22% vs 12%, p<0.001 and 11% vs 5%, p = 0.003, respectively). Loss of autonomy including poor adherence to medication was more prevalent in case of cognitive impairment (69% vs 29%, p<0.001). Sodium restriction (79% vs 86%, p = 0.003) and physical activity were lower (31% vs 55.5%, p<0.001) in patients with cognitive disorders than in those normal cognitive function. The prevalence of cognitive disorders was high (46%) in HF elderly patients. These patients were more frail than those with normal cognitive function. The results suggest a poorer prognosis in HF patients with cognitive disorders and justify a longitudinal follow up to determine the impact of cognition on morbi-mortality.

A propensity-matched study of low serum potassium and mortality in older adults with chronic heart failure

Objective Most HF patients are older adults, yet the associations of low serum potassium and outcomes in these patients are unknown. We studied the effect of low serum potassium in a propensity-matched population of elderly HF patients. Methods Of the 7788 patients in the Digitalis Investigation Group trial, 4036 were ≥ 65 years. Of these, 3598 had data on baseline serum potassium and 324 with potassium ≥ 5 mEq/L were excluded. Remaining patients were categorized into low (< 4 mEq/L; n = 590) and normal (4–4.9 mEq/L; n = 2684) potassium groups. Propensity scores for low-potassium, calculated for each patient, were used to match 561 low-potassium and 1670 normal-potassium patients. Association of low potassium and outcomes were assessed using matched Cox regression analyses. Results Patients had a mean (± SD) age of 72 (± 6) years, 29% were women and 12% were non-whites. Of the 561 low-potassium patients, 500 had low-normal (3.5–3.9 mEq/L) potassium. All-cause mortality occurred in 37% (rate, 1338/10,000 person-years) normal-potassium and 43% (rate, 1594/10,000 person-years) low-potassium patients (hazard ratio {HR} for low-potassium, 1.22; 95% confidence interval {CI}, 1.04–1.44; p = 0.014). Low-normal (3.5–3.9 mEq/L) potassium levels had a similar association with mortality (HR, 1.19, 95% CI, 1.00–1.41, p = 0.049). Low (HR, 1.10; 95% CI, 0.96–1.25; p = 0.175) or low-normal (HR = 1.09, 95% CI = 0.95–1.25, p = 0.229) serum potassium levels were not associated with all-cause hospitalization. Conclusions In a propensity-matched population of elderly ambulatory chronic HF patients, well-balanced in all measured baseline covariates, low and low-normal serum potassium were associated with increased mortality but had no association with hospitalization.

Depressive symptoms are prominent among elderly hospitalised heart failure patients

There are limited data on the prevalence of depressive symptoms in hospitalised elderly HF patients and demographic and clinical characteristics associated with depressive symptoms are not known. A sample of 572 HF patients (61% male; age 71+/-12 years; LVEF 34%+/-15) was recruited from 17 Dutch hospitals during HF admission. Depressive symptoms were assessed by the CES-D. Demographic, clinical variables and HF symptoms were collected from patient chart and interview. Forty one percent of the patients had symptoms of depression with women significantly more often reporting depressive symptoms than men 48% vs. 36% (chi(2)=8.1, p<0.005). HF patients with depressive symptoms reported more clinical HF symptoms than patients without depressive symptoms. Even after deleting HF related symptoms (sleep disturbances and loss of appetite) from the CES-D scale, 36% of patients were still found to have symptoms of depression. Multivariable logistic regression analyses revealed that depressive symptoms were associated with female gender (odds 1.68, 95% CI 1.14-2.48), COPD (odds 2.11, 95% CI 1.35-3.30), sleep disturbance (odds 3.45, 95% CI 2.03-5.85) and loss of appetite (odds 2.61, 95% CI 1.58-4.33). Depressive symptoms are prominent in elderly hospitalised HF patients especially in women. Depressive symptoms are associated with more pronounced symptomatology, despite the fact that other indices of severity of left ventricular dysfunction are similar.

Health related quality of life of elderly patients with end-stage heart failure

(77% vs. 65%, p .001) and exercise (67% vs. 55%, p .021) than younger patients. There was no difference in other compliance behaviors (keeping appointments, medication, smoking/alcohol use). Of the 70 elderly patients, 51% reported difficulty complying with exercise while 37%, 24%, and 23% had difficulty with diet, keeping appointments, and medication use, respectively. Nine percent and 18% continued to smoke and drink. Common barriers that led to noncompliance with keeping appointments and taking medications were lack of transportation, time and money. Lack of motivation, self-control, and support led to poor compliance with diet and smoking/alcohol use, while physical symptoms and lack of energy accounted for poor exercise compliance. We found a strong association (p .01) between degree of difficulty and actual compliance with each of the medical regimens in elderly HF patients. Conclusion: Elderly HF patients report low compliance behaviors that are associated with degree of difficulty following prescribed regimens. Interventions that target the common barriers cited by elderly patients may be key to improved compliance behaviors in this vulnerable population.

Elderly HF patients benefit from rapid diuresis with furosemide

Elderly HF patients benefit from rapid diuresis with furosemide

Elderly HF patients benefit from rapid diuresis with furosemide

Elderly HF patients benefit from rapid diuresis with furosemide

ACE inhibitors underused in elderly HF patients

ACE inhibitors underused in elderly HF patients

Renal function in the elderly: Impact of hypertension and cardiac function

In senescence renal function is thought to decline markedly even in the absence of renal disease. It has also been proposed that the changes in renal function with age are not uniform and that confounding factors such as hypertension or atherosclerosis may play a role. We performed a comprehensive study to compare several aspects of renal function in four groups: (i) young healthy normotensive subjects (N = 24; 13 males; mean age 26 +/- 3 years); (ii) elderly healthy normotensive subjects (elderly NT; N = 29; 13 males; 68 +/- 7 years); (iii) elderly treated and untreated hypertensive patients (elderly HT; N = 25; 13 males; 70 +/- 6 years); and (iv) elderly patients with compensated mild to moderate heart failure (elderly HF; N = 14; 6 males; 69 +/- 6 years). Compared to young subjects mean GFR (C(In)) and ERPF (C(PAH)) were significantly lower in the elderly, despite similar mean plasma creatinine levels (young, 121 +/- 11, 650 +/- 85 ml/min/1.73 m2; elderly NT, 103 +/- 11, 486 +/- 102; elderly HT, 103 +/- 13, 427 +/- 55; elderly HF, 92 +/- 14, 377 +/- 103). Nevertheless, GFR was within the normal range in the majority of elderly NT and HT, but not in elderly HF. ERPF was significantly lower in elderly HT as compared with elderly NT, and still lower in elderly HF. Mean renovascular resistance and filtration fraction were significantly higher in the elderly, particularly in elderly HT and HF as compared with the young. Mean fractional excretion of Na+ was similar in all groups studied, but the lithium clearance was significantly lower in the elderly, suggesting a greater proximal and less distal sodium reabsorption in senescence. In the elderly, mean PTH concentration and urinary excretion of pyridoline cross-links were significantly higher and mean 25-(OH)D3, calcitriol and phosphate concentrations significantly lower; the correlation between PTH and GFR was significant (r = -0.432, P < 0.001). The results document that the decrease in renal hemodynamics with senescence is less marked than suggested by some studies using less stringent methodology and inclusion criteria. Comorbid conditions confound renal function in the elderly. Age-associated changes in renal hemodynamics are accompanied by significant alterations of renal hormones and of renal sodium handling.