Heart failure in the elderly:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2000
|
| Schriftenreihe: | Clinics in geriatric medicine
16,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVIII S., S. 407 -681 Ill., graph. Darst. |
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| 650 | 4 | |a Insuffisance cardiaque | |
| 650 | 4 | |a Aged | |
| 650 | 4 | |a Geriatric cardiology | |
| 650 | 4 | |a Heart Failure, Congestive | |
| 650 | 4 | |a Heart failure | |
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| adam_text | HEART FAILURE IN IHf. F.UMKl.Y
CONTENTS
Preface xvii
Michael W. Rich
Epidemiology and Risk Factors for Heart Failure
in the Elderly 407
Douglas D. Schocken
Heart failure is a common problem in the elderly population, af¬
fecting 10% or more of persons more than 80 years of age. Heart
failure is most likely to develop in the elderly population, with an
annual incidence of 20 to 30 cases per 1000 persons aged more than
80 years. Heart failure is not only common in the elderly popula¬
tion but also commonly fatal, with fewer than 30% of elderly per¬
sons surviving 6 years after their first hospitalization for heart fail¬
ure. Common risk factors leading to heart failure include coronary
heart disease, systolic hypertension, and diabetes mellitus. The
global aging of the population will perpetuate the epidemic of
heart failure into the next century.
Cardiovascular Aging in Health 419
Edward G. Lakatta
Major focuses of geriatric medicine are cardiovascular diseases
with increases in prevalence in older people and how aging might
modify the risk factors, clinical manifestations, treatment strate¬
gies, and prognoses of these diseases. Quantitative information on
age associated alterations in cardiovascular structure and function
in health is essential to define and target the specific characteristics
of the cardiovascular aging process that render it the major risk
factor for cardiovascular diseases. Such information also is re¬
quired to differentiate among the limitations of elderly individuals
that relate to disease and limitations that may fall within expected
normal limits. Differences in cardiovascular function between
older and younger individuals have been described extensively in
the literature, but confusion often arises in the interpretation of
CLINICS IN GERIATRIC MEDICINE
VOLUME 16 NUMBER 3 AUGUST 2000 IX
these differences because of a failure to acknowledge or to control
for interactions among age, disease, and lifestyle. The Baltimore
Longitudinal Study on Aging has made an effort to characterize
the effects of aging on multiple aspects of cardiovascular structure
and function. The concepts that have evolved from this and other
studies are discussed.
Clinical Manifestations, Diagnostic Assessment, and Etiology
of Heart Failure in Elderly Patients 445
Donald D. Tresch
Heart failure in elderly patients may be difficult to diagnose be¬
cause of a lack of typical symptoms and physical findings that are
common in younger patients with this disorder. When present, the
symptoms and signs are often nonspecific and mistakenly may be
thought to be caused by other disorders that are commonly present
in elderly patients. In older elderly patients, the symptoms and
signs may be obscured by the presence of aging changes or other
diseases. As a result of these problems, physicians must be highly
suspicious of heart failure in all elderly patients who have under¬
lying heart disease or who present with nonspecific symptoms that
may represent heart failure. After the diagnosis of heart failure is
established, the cause must be determined and systolic and dia
stolic ventricular dysfunction must be differentiated.
Role of Echocardiography in the Diagnosis and Management
of Heart Failure in the Elderly 457
Vincent L. Sorrell and Navin C. Nanda
Heart failure is the most common cause of cardiovascular hospi
talization in older adults in the United States. This disease is com¬
mon, disabling, and commonly fatal, especially in the elderly popu¬
lation. Hypertension and coronary artery disease are the leading
causes of heart failure. A precise diagnosis of the cardiac abnor¬
mality is paramount for adequate treatment, and echocardiogra¬
phy offers the most comprehensive, noninvasive evaluation. With
an organized approach using two dimensional and Doppler echo¬
cardiography, the systolic and diastolic left ventricular perfor¬
mance can be determined; the cardiac output, pulmonary artery,
and ventricular filling pressures can be estimated; and surgically
correctable valve disease can be identified. The response and suc¬
cess of treatment also may be monitored by the judicious use of
echocardiography.
Nonpharmacologic Treatment of Heart Failure in the Elderly 477
Daniel J. Lenihan and Barry F. Uretsky
Nonpharmacologic therapy is an integral part of the management
of elderly patients with heart failure. Reinforcement of dietary so
X CONTENTS
dium restriction and other nutritional concerns are critical features
of therapy. Quality standards for the management of patients with
heart failure are being developed, and the implementation of these
standards is a goal of clinicians. A multidisciplinary approach to
elderly patients with heart failure is beneficial.
Heart Failure with Normal Systolic Function 489
Dalane W. Kitzman
Contrary to popular belief, population studies indicate that most
elderly patients with heart failure have preserved left ventricular
systolic function (i.e., presumed diastolic heart failure). Several
normal aging changes may predispose older individuals to dia¬
stolic heart failure, including increased hypertrophy and stiffness
of the left ventricle, increased vascular stiffness, and decreased car¬
diovascular reserve. Progress in diastolic heart failure has been hin¬
dered by a lack of standard case definition; absence of a readily
available, reliable test to quantitate diastolic function; poor under¬
standing of the pathophysiology of heart failure; and lack of data
from randomized, controlled, multicenter trials. Typical patients
are older women with chronic hypertension, left ventricular hyper¬
trophy, chronic exercise intolerance, and occasional acute exacer¬
bations (pulmonary edema). Although heart failure is a clinical,
bedside diagnosis, echocardiography is helpful in differentiating
diastolic from systolic heart failure and in ruling out other disor¬
ders. Although optimal pharmacologic therapy has not been clar¬
ified, control of blood pressure; exercise conditioning; and a multi
disciplinary, case management approach seem beneficial.
Drug Therapy of Heart Failure Caused by Systolic
Dysfunction in the Elderly 513
Nancy K. Sweitzer, William H. Frishman,
and Lynne Warner Stevenson
The presence of multiple medical illnesses often distinguishes el¬
derly patients with heart failure and can make pharmacologic man¬
agement of symptomatic heart failure challenging in this popula¬
tion. Physiologic changes that occur with normal aging may
complicate clinical assessment. Limited data from large clinical tri¬
als of heart failure therapy are applicable to aged patients. Avail¬
able data suggest that elderly patients should be treated with the
same regimen as younger patients but that more careful attention
should be paid to dosing, especially when initiating a new drug.
History and physical examination techniques can be used to un¬
cover evidence of congestion and inadequate perfusion and are
critical adjuncts when making therapeutic decisions. The objectives
of therapy for elderly patients with heart failure must be individ¬
ualized within the larger context of patients goals and stage of life.
CONTENTS xi
Heart Failure Complicating Acute Myocardial Infarction 535
Wilbert S. Aronow
Older people with congestive heart failure associated with acute
myocardial infarction should be treated with loop diuretic therapy.
Class I indications for the use of early intravenous beta blockade
in patients with acute myocardial infarction are patients without a
contraindication to beta blockers who can be treated within 12
hours of onset of myocardial infarction; patients with continuing
or recurrent ischemic pain; and patients with tachyarrythmias,
such as atrial fibrillation with a rapid ventricular rate. Class I in¬
dications for the use of angiotensin converting enzyme inhibitors
during acute myocardial infarction are (1) patients within the first
24 hours of onset of a suspected acute myocardial infarction with
ST segment elevation in two or more anterior precordial leads or
with clinical heart failure in the absence of significant hypotension
or contraindications to the use of angiotensin converting enzyme
inhibitors, (2) patients with myocardial infarction and a left ven¬
tricular ejection fraction of less then 40%, (3) and patients with
clinical heart failure on the basis of systolic pump dysfunction dur¬
ing and after convalescence from acute myocardial infarction. No
class I indications exist for using calcium channel blockers or mag¬
nesium during acute myocardial infarction.
Interventional Therapy in Heart Failure Management 549
Kevin Marzo, Florence M. Prigent, and Richard M. Steingart
The incidence and prevalence of congestive heart failure are rap¬
idly increasing because of the progressive decrease in age adjusted
mortality rates for coronary artery disease and hypertensive heart
disease, together with the progressive aging of the US population.
Despite great advances in maximal medical therapy, most patients
with symptomatic congestive heart failure can expect functional
impairment, interludes of worsening symptomatology, and a
shortened life span. Thus, it is appropriate to ask whether the in¬
terventional revolution that is under way for the management of
ischemic cardiovascular disease can be applied with benefit to the
management of congestive heart failure. The use of interventional
therapies for the treatment of elderly patients with congestive heart
failure caused by coronary artery disease, valvular heart disease,
or renal vascular disease is addressed.
Surgical Management of Heart Failure 567
Mark S. Slaughter and Herbert B. Ward
Surgical therapy for congestive heart failure can offer gratifying
results in selected elderly patients. Several trials have shown a sur¬
vival advantage for surgical revascularization compared with
medical therapy in the treatment of ischemic cardiomyopathy. Aor¬
tic valve replacement is highly effective in treating elderly patients
with heart failure caused by severe aortic stenosis, and stentless
xii CONTENTS
aortic valves seem to provide a survival advantage in elderly pa¬
tients with low gradient aortic stenosis. Mitral valve repair with or
without coronary revascularization has been used successfully in
patients with severe mitral regurgitation. Transplantation is a vi¬
able but rarely used option for elderly patients with congestive
heart failure. Totally implantable ventricular assist devices are an
exciting new option for elderly patients with congestive heart fail¬
ure who are not heart transplantation candidates.
Management of Arrythmias 593
Rachel Lampert and Michael D. Ezekowitz
The management of arrhythmias in elderly patients with conges¬
tive heart failure, including atrial fibrillation, ventricular tachyar
rhythmias, and bradyarrhythmias, is described. Patients with atrial
fibrillation can be treated with rate control anticoagulation for
stroke prevention or by attempt at cardioversion and maintenance
of sinus rhythm. Elderly patients remaining in atrial fibrillation
benefit from anticoagulation provided that no contraindication ex¬
ists. In patients surviving malignant ventricular arrhythmias, de
fibrillator implantation is beneficial in elderly patients with heart
failure. Prognosis and treatment of nonsustained arrhythmias de¬
pends on the presence of underlying cardiac abnormalities. In the
healthy elderly population, treatment is not indicated. In patients
with coronary artery disease, decreased ejection fraction, and non
sustained ventricular tachycardia, electrophysiology can further
stratify risk, and defibrillator implantation can improve survival if
arrhythmias are induced. This benefit is as great in elderly patients
as in younger patients. Symptomatic bradycardias are increasingly
common with advancing age. Symptoms are improved with pac¬
ing, with maximum benefit from physiologic rather than ventric¬
ular pacing. Although the elderly population poses a unique chal¬
lenge when faced with arrhythmias, an active approach not only
saves lives but also reduces morbidity.
Cardiac Rehabilitation and Secondary Prevention Programs
for Elderly Cardiac Patients 619
Daniel E. Forman and William Farquhar
The utility of cardiac rehabilitation for elderly cardiac patients is
controversial, and cost, logistic barriers, and encumbering comor
bidities often seem disproportionate. Many clinicians view the em¬
phasis of cardiac rehabilitation on behavior modification and risk
factor reduction as irrelevant for very old adults and consider pure
exercise programs as appropriate alternatives. The strong rationale
for cardiac rehabilitation and secondary prevention is elucidated,
and available corroborating data are presented. The benefits of ex¬
ercise prescription in cardiac rehabilitation and synchronized risk
factor reduction are pertinent to aging and age related heart dis¬
ease, including coronary heart disease and heart failure.
CONTENTS xiii
Comorbidity in Heart Failure in the Elderly 631
Paul E. McGann
Heart failure occurs principally in the geriatric population and of¬
ten is associated with severe comorbidity. Comorbid conditions
that occur in the geriatric population at a prevalence equal to or
greater than that of heart failure itself include the brain failure syn¬
dromes (i.e., delirium and dementia), depression, falls, postural
hypotension, urinary incontinence, undernutrition, frailty, sensory
deprivation, polypharmacy, and lack of social support. The effect
of major geriatric comorbidities on the management of patients
with heart failure is reviewed.
Psychosocial Considerations in Elderly Patients
with Heart Failure 649
Kenneth E. Freedland and Robert M. Carney
Neuropsychiatric conditions, such as Alzheimer s dementia, and
complications, such as delirium, are common in elderly patients
with heart failure. Persistent alcohol abuse and cigarette smoking
sometimes contribute to the onset and progression of heart failure.
Major depression and other depressive disorders are common in
this population and have adverse effects on functional status, qual¬
ity of life, and prognosis. Anxiety and social isolation are clinically
significant problems in many cases. These problems often are treat¬
able and deserve more clinical attention than they typically receive.
End of Life Care for Elderly Patients with Heart Failure 663
Gottlieb C. Friesinger II and Javed Butler
The mortality rate of elderly persons with heart failure is high de¬
spite the introduction of several effective therapeutic interventions
during the past decade. The management of end of life, often as¬
sociated with distressing symptoms and multiple hospitalizations,
is a significant clinical problem. Skillful and effective management
requires expert knowledge of the heart failure syndrome, but the
critical dimension of care relates to detailed knowledge about a
patient s comorbidities, extent of debility, values, and desires. Dis¬
cussing end of life issues early in the course of illness is essential
for determining the appropriate levels of intensity of care and for
defining the circumstances in which patients wish to be hospital¬
ized and when hospital care offers little potential for increased
comfort or longevity. Early and repeated discussions are needed
to consider matters such as living wills, do not resuscitate orders,
and power of attorney. In light of the complexity of the health care
system, including involvement of multiple caregivers, end of life
issues are among the most demanding of a physician s time, but
when end of life care is managed effectively, health care providers
Xiv CONTENTS
often are rewarded with the gratitude of patients and their families
for minimizing suffering and providing optimal opportunities for
patients to participate in the affairs of family and the community.
Index 677
Subscription Information Inside back cover
CONTENTS xr
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| spelling | Heart failure in the elderly Michael W. Rich Philadelphia [u.a.] Saunders 2000 XVIII S., S. 407 -681 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in geriatric medicine 16,3 Cardiologie - Sujet âgé Cardiologie gériatrique Défaillance cardiaque - Sujet âgé Insuffisance cardiaque Aged Geriatric cardiology Heart Failure, Congestive Heart failure Herzinsuffizienz (DE-588)4024655-3 gnd rswk-swf Alter (DE-588)4001446-0 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Herzinsuffizienz (DE-588)4024655-3 s Alter (DE-588)4001446-0 s DE-604 Rich, Micheal W. Sonstige oth Clinics in geriatric medicine 16,3 (DE-604)BV000019839 16,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009093918&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Heart failure in the elderly Clinics in geriatric medicine Cardiologie - Sujet âgé Cardiologie gériatrique Défaillance cardiaque - Sujet âgé Insuffisance cardiaque Aged Geriatric cardiology Heart Failure, Congestive Heart failure Herzinsuffizienz (DE-588)4024655-3 gnd Alter (DE-588)4001446-0 gnd |
| subject_GND | (DE-588)4024655-3 (DE-588)4001446-0 (DE-588)4143413-4 |
| title | Heart failure in the elderly |
| title_auth | Heart failure in the elderly |
| title_exact_search | Heart failure in the elderly |
| title_full | Heart failure in the elderly Michael W. Rich |
| title_fullStr | Heart failure in the elderly Michael W. Rich |
| title_full_unstemmed | Heart failure in the elderly Michael W. Rich |
| title_short | Heart failure in the elderly |
| title_sort | heart failure in the elderly |
| topic | Cardiologie - Sujet âgé Cardiologie gériatrique Défaillance cardiaque - Sujet âgé Insuffisance cardiaque Aged Geriatric cardiology Heart Failure, Congestive Heart failure Herzinsuffizienz (DE-588)4024655-3 gnd Alter (DE-588)4001446-0 gnd |
| topic_facet | Cardiologie - Sujet âgé Cardiologie gériatrique Défaillance cardiaque - Sujet âgé Insuffisance cardiaque Aged Geriatric cardiology Heart Failure, Congestive Heart failure Herzinsuffizienz Alter Aufsatzsammlung |
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