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Diastolic heart failure in the elderly.
1Cardiology Section, Department of Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA. dkitzman@wfubmc.edu
Heart Failure Reviews
|January 16, 2002
Summary
Diastolic heart failure (DHF) is common in older adults, especially women, often linked to hypertension. While less fatal than systolic heart failure in outpatients, its prevalence means DHF causes more total deaths in the elderly.
Area of Science:
- Cardiology
- Geriatrics
- Heart Failure Research
Background:
- Diastolic heart failure (DHF) is a significant and increasingly recognized condition in the elderly population.
- Age-related cardiovascular changes may predispose individuals to DHF.
- Limited understanding exists regarding DHF's epidemiology, pathophysiology, natural history, and treatment.
Purpose of the Study:
- To review the current understanding of diastolic heart failure in older Americans.
- To highlight the epidemiological and clinical characteristics of DHF.
- To emphasize the need for further research and clinical trials.
Main Methods:
- Review of large population-based observational studies.
- Analysis of epidemiological data on heart failure in individuals aged 65 and older.
- Synthesis of information on pathophysiology, natural history, and therapeutic approaches.
Main Results:
- Over 50% of elderly heart failure patients have normal systolic function (presumed DHF).
- Isolated DHF affects 45% of these patients, predominantly older women, often with hypertension and left ventricular hypertrophy.
- DHF has lower outpatient mortality than systolic heart failure (SHF) but similar mortality in hospitalized/very elderly patients; overall DHF mortality in the elderly exceeds SHF due to prevalence.
Conclusions:
- DHF is a prevalent and serious condition in older adults, contributing significantly to overall mortality and morbidity.
- Patients experience reduced quality of life, exercise intolerance, and frequent acute exacerbations.
- Current therapies are empirical, underscoring the urgent need for randomized controlled trials to guide evidence-based treatment.