CONGESTIVE-HEART-FAILURE IN THE ELDERLY - AN INTRIGUING CLINICAL REALITY

Background: The purpose of this study was to identify the etiology, pr ecipitating factors, and main findings from clinical examination and n oninvasive laboratory investigation in congestive heart failure (CHF) in advanced age. Methods: This was an observational study conducted in the geriatric ward of the A. Gemelli University Hospital, Rome. A tot al of 154 consecutive subjects (age, 75 +/- 8 years; range, 60 to 98 y ears) hospitalized with CHF were included in the study. All subjects w ere assessed for history and underwent physical examination, ECG, cros s-sectional echocardiography, chest radiography, and routine blood che mistry; in selected patients, Tl-201 myocardial scintigraphy and Doppl er echocardiography were used. Results: A multiple etiology of CHF was found in 56% of the patients. Coronary artery disease was the most co mmon single cause of CHF (71%), followed by hypertension (45%), valvul ar heart disease (32%), and chronic cor pulmonale (13%). Factors preci pitating CHF were evident in 62% of the patients, the most common bein g atrial fibrillation (16%), use of nonsteroidal anti-inflammatory dru gs (10%), lack of compliance with drugs (10%), renal failure (8%), fev er (6.5%), and anemia (6%). Left ventricular systolic function, as ass essed by echocardiography, was normal in 45% of patients. In each pati ent the diagnosis of CHF was associated with an average of five unrela ted diseases. New York Heart Association (NYHA) class III to IV severi ty was the only condition that correlated with a higher prevalence of impaired systolic function. Conclusions: In elderly patients, CHF repr esents a complex entity whose diagnosis and treatment requires a compr ehensive approach.