Contemporary management of heart failure in the elderly

Osmanska, J. and Jhund, P. S. (2019) Contemporary management of heart failure in the elderly. Drugs and Aging, 36(2), pp. 137-146. (doi: 10.1007/s40266-018-0625-4) (PMID:30535931)

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Abstract

The foundation of the treatment of heart failure with reduced ejection fraction is a number of pharmacotherapies shown to reduce morbidity and mortality in large randomised multinational clinical trials. These include angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and more recently, a combined angiotensin receptor blocker neprilysin inhibitor, sacubitril/valsartan. In select cases, digoxin, ivabradine and hydralazine with isosorbide dinitrate have a role to play in the treatment of heart failure with reduced ejection fraction. On this foundation, other more advanced treatments such as implantable cardioverter defibrillators and cardiac resynchronisation therapy are recommended in guidelines for the treatment of heart failure with reduced ejection fraction (i.e. an ejection fraction of ≤ 40%) and for a select few there remains the option of mechanical circulatory support and cardiac transplantation. The efficacy of pharmacotherapy does not vary by age and each of these therapies should be considered in all patients, irrespective of age. Other factors such as co-morbidities like renal dysfunction may limit the use of some of these drugs in the elderly. Decision making with regard to device therapy is more complex; the likelihood of competing non-cardiovascular causes of death and life expectancy need to be considered. Despite multiple treatment options for heart failure with reduced ejection fraction, the options for heart failure with preserved ejection fraction are limited. In the absence of robust outcomes data from a large randomised trial, a mineralocorticoid receptor antagonist is a reasonable therapy to reduce the risk of hospitalisation for heart failure in patients with heart failure with preserved ejection fraction.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Osmanska, Dr Joanna and Jhund, Dr Pardeep
Authors: Osmanska, J., and Jhund, P. S.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Drugs and Aging
Publisher:Springer
ISSN:1170-229X
ISSN (Online):1179-1969
Published Online:11 December 2018
Copyright Holders:Copyright © 2018 Springer Nature Switzerland AG
First Published:First published in Drugs and Aging 36(2):137-146
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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