International Journal of Gerontology
Volume 1, Issue 4 , Pages 143-152, December 2007

Congestive Heart Failure in the Elderly

  • Chiung-Zuan Chiu

      Affiliations

    • School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
    • Division of Cardiology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • ,
  • Jun-Jack Cheng

      Affiliations

    • School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
    • Division of Cardiology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • School of Medicine, Taipei Medical University, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Jun-Jack Cheng, Division of Cardiology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, 95, Wen-Chan Road, Shih-Lin, Taipei, Taiwan

Accepted 15 July 2007.

Article Outline

Summary 

Over the past 30 years, the prevalence and incidence of heart failure (HF) have increased markedly with age, with increases of approximately fivefold from the age of 40 to 70 years. HF is predominantly a disorder of the elderly, and over 70% of HF patients are over 65 years old. The most important factor in the increasing prevalence and incidence of HF is the growing proportion of elderly with new-onset diastolic HF resulting from chronic hypertension and coronary heart disease. Other predictors of HF include diabetes, prior stroke, atrial fibrillation, renal dysfunction, reduced ankle-brachial index, increased C-reactive protein, left ventricular hypertrophy, reduced forced expiratory volume, and obesity. At least half of all elderly HF patients have preserved left ventricular systolic function, and they are classified as diastolic HF. There was a strong female predominance (67%) in diastolic HF when compared with male HF patients. The morbidity and mortality of older HF patients are the highest of any chronic cardiovascular disorder. Mortality increases markedly with age. Mortality from diastolic HF is about half of that reported for systolic HF. There are some comorbidities in older HF patients, including renal dysfunction, chronic lung disease, cognitive dysfunction, depression, postural hypotension, urine incontinence, sensory deprivation, nutritional disorders, polypharmacy and frailty, which may precipitate and exacerbate the underlying HF symptoms. Clinical diagnosis of HF may be more difficult in the elderly because of frequently inadequate history taking, less evident HF symptoms for reduced daily activity, and similar symptoms to other frequent disorders. The treatment goals in older HF patients resemble those for any chronic disorder and include relief of symptoms, improvement in functional status, exercise tolerance, quality of life, prevention of acute exacerbation, and finally, prolongation of long-term survival.

Key Words:  chronic hypertension , coronary artery disease , diastolic heart failure , elderly , heart failure

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PII: S1873-9598(08)70038-3

doi:10.1016/S1873-9598(08)70038-3

International Journal of Gerontology
Volume 1, Issue 4 , Pages 143-152, December 2007

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