Heart failure in the elderly: advances and challenges

Abstract

The elderly population (age ≥65 years) is increasing, and with it the prevalence of heart failure and associated morbidity, hospitalizations and costs. Despite advances, clinical trial data on heart failure therapy exclusively for elderly patients are lacking. However, trials of therapy for heart failure with left ventricular systolic dysfunction or low ejection fraction in primarily non-elderly patients showed mortality benefit in elderly patients. By contrast, trials for heart failure with normal left ventricular systolic function or preserved ejection fraction have not shown mortality benefit in elderly or non-elderly patients. Heart failure pharmacotherapy in the elderly is challenging; it needs to be individualized and consider aging-specific changes in physiology, drug metabolism, drug pharmacokinetics and tolerance, comorbidities, polypharmacy and drug–drug interactions that can contribute to adverse effects. More research into the biology of aging and clinical trials in elderly patients may lead to the discovery of new therapies for heart failure in the elderly.

Keywords::

• elderly
• heart failure/low ejection fraction
• heart failure/preserved ejection fraction
• therapy

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

LV: Left ventricular; STEMI: ST-elevation myocardial infarction.

ACS: Acute coronary syndrome; CHD: Coronary heart disease; ECM: Extracellular collagen matrix; LV: Left ventricular; MMP: Matrix metalloproteinase; NO: Nitric oxide; PAI-1: Plasminogen activator inhibitor-1; TIMP: Tissue inhibitor of metalloproteinase.

CABG: Coronary artery bypass surgery; LVAD: Left ventricular assist device; RVAD: Right ventricular assist device.