Heart Failure
Heart failure is a frequent disease in the elderly cohort. In most cases, coronary artery disease and myocardial infarction or arterial hypertension that had remained uncontrolled for years, resulting in diffuse myocardial damage (fibrosis, hypertrophy) a
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Relevance for Elderly Patients, Epidemiology Heart failure is a frequent disease in the elderly cohort. In most cases, coronary artery disease and myocardial infarction or arterial hypertension that had remained uncontrolled for years, resulting in diffuse myocardial damage (fibrosis, hypertrophy) and systolic failure, are the culprits. Heart failure can be considered as a progressive disorder that is superimposed on the aging process in a disease continuum (Fig. 1; Jugdutt 2010). The high prevalence of both conditions in elderly patients frequently results in mixed etiologies. While hospitalization and 1-year mortality rates for heart failure appear to be decreasing, the incidence of this syndrome continues to increase due to the aging of the population (Chen et al. 2011). The incidence of heart failure increases from 0.02/1,000 inhabitants at age 24–39 years to 11.6/1,000 inhabitants aged 85+, with a clear dominance of men (Fig. 2; Cowie et al. 1999). In the general population, about 1% of all people suffer from heart failure; in persons
M. Wehling (*) University of Heidelberg, Maybachstr. 14, Mannheim 68169, Germany e-mail: [email protected] R.L. Page 2nd School of Pharmacy, University of Colorado, Mail Stop C238, 12850 E Montview Blvd. V20-4125, Aurora, CO 80045, USA e-mail: [email protected]
aged 85+, this figure rises to greater than 30% (Roger et al. 2011; data from Framingham, Fig. 3). The immense impact of this disease on human health and well-being is underlined by the following data on prognosis: Depending on the stage of heart failure (classification according to the New York Heart Association [NYHA], stages I–IV), 1-year mortality increases from 10% in stage I to almost 50% in stage IV. Thus, this disease has a higher mortality than many malign diseases. Mortality at all stages is 50% in 5 years. The Framingham study showed that age is a strong risk predictor in that mortality increases by 27% in males and even 61% in females per decade (Ho et al. 1993). The latter figure shows that heart failure is no “male” disease in the elderly, but females catch up and may even take the lead at very high age. Concomitant diseases are frequent, and treatment of heart failure in the aged thus is a bigger challenge than in the young (Table 1). In particular, arterial hypertension, which showed a prevalence of 79% in patients over 75 years (Brunner-La Rocca et al. 2006); kidney failure (59%); stroke; and the presence of two and more diseases sharply rise with age. In an analysis of the National Health and Nutritional Examination Survey (NHANES), the proportion of patients with heart failure who had five or more comorbidities increased from 42.1% in 1988–1994 to 58.0% in 2003–2008 (Wong et al. 2011). These concomitant diseases need to be considered in the treatment regimen of elderly patients with heart failure.
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_7, # Springer-Verlag Wien 2013
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Fig. 1 The relationship betwee
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