Download CHF in the Elderly

University of Alabama at Birmingham
School of Medicine
CHF in Older Adults

The incidence and prevalence of the heart failure is strikingly age-dependent: It is
uncommon in individuals less than 45years old, doubles each decade thereafter and
approaches 10% in adults over 80 years of age.

CHF is currently the leading indication for hospitalization in individuals over 65 years of
age. Heart failure ranks second to hypertension among cardiovascular causes for
outpatient visits.

The changes associated with cardiovascular aging result in a reduced ability of the heart
to respond to stress, whether physiological or pathological; increased vascular stiffness;
alterations in cardiac relaxation and stiffness, and altered myocardial energy metabolism
at the level of mitochondria.

The etiology of heart failure is multifactorial in older patients compared to younger
adults. HTN and CAD are the most common causes of CHF in 70% of cases. Heart
failure in older patients is often precipitated by acute or worsening non-cardiac
conditions, such as pneumonia, pulmonary embolism, COPD exacerbations and
pyelonephritis.

While the most common symptoms of CHF in older adults are exertional dyspnea,
orthopnea, fatigue, dependent edema and exercise intolerance.Atypical symptomatology
in those over 80 years old is common and include nonspecific systemic complaints,
confusion, irritability, sleep disturbances and gastrointestinal disorders, such as anorexia,
abdominal discomfort, nausea and diarrhea.

Physical findings may be atypical and nonspecific like impaired sensorium and Cheyne
Stokes respirations.

Optimal therapy in older patients comprise three principle components; correction of
underlying etiology whenever possible, attention to non-pharmacological and
rehabilitative aspects of treatment and judicious use of medications.

In older heart failure patients, drugs should be started at lower doses and gradually
increased (e.g., captopril 6.25- 12.5 mg tid- qid or enalapril 2.5-5 mg bid).

Due to age-related changes in renal function and a higher prevalence of comorbid
illnesses, elders are at increased risk for serious diuretic–induced electrolyte
abnormalities; hence, electrolytes should be monitored closely when diuretic therapy is
adjusted.

Therapeutic range for digoxin is lower in older patients: A serum digoxin concentration
of 0.5 to 1.5 ng/ml is appropriate.

In elderly patients, prognosis is typically worse than that of younger patients: Only 20%
survive more than 5 years.
References
1.J.Cardiology clinics vol17,no.1,Feb 1999
University of Alabama at Birmingham
School of Medicine
2.J.of American Geriatric society 1997,Aug.45 (8):968-74
3.Princples of Geriatrics : Hazzard, Textbook
Supported by a grant from the Association of American Medical Colleges and the John A. Hartford
Foundation.