CONGESTIVE-HEART-FAILURE IN THE ELDERLY

Several aspects of congestive heart failure are discussed in the light of international literature and of recent findings of our group. The annual incidence of heart failure in elderly subjects, aged greater th an or equal to 75 y, is 13 to 50/1000, while it is 1.6/1000 in people aged 45-54 y. The prevalence of heart failure is about 3% in subjects aged 45-64 y, 6% in subjects aged more than 65 y and 10% in subjects a ged more than 75 y. These data are confirmed by our population based s tudy in elderly subjects. The etiology of congestive heart failure is similar in elderly and middle-aged patients. However, several anatomo- functional, hormonal and autonomic nervous system changes, typical of congestive heart failure, occur during physiologic ageing processes al so. These findings may explain the dramatic evolution of congestive he art failure in elderly patients. Moreover, some features of the elderl y - e.g. comorbidity, atypical clinical presentations, loss of autonom y, increased iatrogen risk should be considered. No specific drugs exi st for the pharmacologic treatment of heart failure in the elderly, so that the geriatric specificity in the treatment of heart failure can be recognized in the art of drug choice and dosage, to obtain the best results with the least side effects. The multiple etiology of congest ive heart failure, the comorbidity, the loss of autonomy and the deter ioration of cognitive functions suggest the need for multidimensioal a pproach and continuative intervention in elderly patients with heart d isease, and in particular with congestive heart failure. Further studi es on disease- and age-related changes are necessary to develop new an d mort potent strategies lo secure 'successful ageing'. Copyright (C) 1996 Elsevier Science Ireland Ltd