Abstract and Introduction
The prevalence of heart failure (HF) increases with age. While clinical trials suggest that contemporary evidence-based HF therapies have reduced morbidity and mortality, these trials largely excluded the elderly. Questions remain regarding the clinical characteristics of elderly HF patients and the impact of contemporary therapies on their outcomes. This review presents the epidemiology of HF in the elderly and summarizes the data on the pathophysiology of the ageing heart. The clinical characteristics, treatment patterns, and outcomes of elderly HF patients are explored. Finally, the main gaps regarding HF therapies in the elderly and the opportunities for future trials are highlighted.
Heart failure (HF) is a major and growing public health problem worldwide, with high morbidity, mortality, and cost. Despite recent improvements in the outcomes of patients with chronic HF through contemporary therapies, concerns exist as to whether the subjects included in major HF clinical trials were representative of real-world patients. In particular, the elderly are under-represented in clinical trials and may be at an increased risk for worse outcomes.
A consensus definition of elderly does not exist. Traditionally, 65 years have been considered the conventional threshold for older age, since this age cut-off has historically represented a common age for retirement in many cultures. However, increased life expectancy may make this age cut-off inappropriately low. Recent HF studies classified 'elderly' patients heterogeneously, as those older than 70 to 80 years, while patients older than 85 years were often classified as 'very elderly'. This latter cut-off has been proposed as potentially a more appropriate threshold for old age.
Regardless of the specific definition for elderly, it is clear that HF is primarily a condition of the older population in developed countries. Elderly HF patients demonstrate distinctive pathophysiological features, complex co-morbidity profiles, and unique issues of medication tolerance. Our understanding of proper patient management of the elderly is limited by their frequent referral to general practitioners (GPs) or geriatricians rather than cardiologists, as well as by their under-representation in major HF trials. In this review, we summarize the current data on HF in the elderly, focusing on the pathophysiology of the ageing heart, and the clinical characteristics and outcomes. The differential response to HF therapies in the elderly and the opportunities for future investigation are also highlighted.