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Heart failure in older people: causes, diagnosis and treatment
1Acute and Elderly Medicine, Northern General Hospital, Harries Road, Sheffield S5 7AU, UK. ahmedhafiz@hotmail.com
Insights
Congestive heart failure (CHF) is common in older adults, often caused by hypertension and coronary heart disease. Nurse-led multidisciplinary care improves survival and quality of life for CHF patients.
Area of Science:
- Geriatrics
- Cardiology
- Internal Medicine
Background:
- Congestive heart failure (CHF) prevalence increases with age, affecting over 5% of those 65-75 and 10-20% of those >80 in the UK.
- Hypertension and coronary heart disease are primary drivers, with valvular heart disease increasingly implicated.
- Non-compliance with medication/diet and NSAIDs are common CHF exacerbants in the elderly.
Purpose of the Study:
- To review the epidemiology, diagnosis, and management of congestive heart failure in older adults.
- To highlight diagnostic challenges and potential future indicators like brain natriuretic peptide.
- To evaluate the impact of multidisciplinary interventions on CHF patient outcomes.
Main Methods:
- Literature review of congestive heart failure in the elderly population.
- Analysis of common causes, precipitants, and diagnostic challenges.
- Evaluation of current management strategies for systolic and diastolic heart failure.
- Assessment of nurse-directed, multidisciplinary intervention effectiveness.
Main Results:
- Diagnosis can be challenging due to masked symptoms; plasma brain natriuretic peptide shows diagnostic promise.
- Conventional therapy (diuretics, ACE inhibitors, beta-blockers) manages systolic CHF.
- Diastolic CHF management requires symptom control, ischemia prevention, and treating underlying causes.
- Multidisciplinary interventions significantly improve event-free survival and quality of life.
Conclusions:
- Congestive heart failure is a growing concern in the elderly, requiring comprehensive management strategies.
- Early diagnosis and tailored treatment, including addressing non-compliance and NSAID use, are crucial.
- Nurse-directed, multidisciplinary care models offer substantial benefits for CHF patients, enhancing both survival and quality of life.
Abstract:
Congestive heart failure affects >5% of those aged 65-75 and 10-20% of those aged >80 in the UK, and levels are likely to rise in the wake of improved therapies for hypertension and myocardial infarction. It is often multifactorial in this group. The most common causes are hypertension and coronary heart disease, with valvular heart disease playing an increasing role. The most common precipitant of pre-existing heart failure is non-compliance with medication or diet; non-steroidal anti-inflammatory drugs are particularly likely to exacerbate the condition. Diagnosis may be difficult since typical signs are often absent or masked in older people, but plasma levels of brain natriuretic peptide appear to be a reliable indicator and may provide diagnostic test in the future. Systolic heart failure is managed by conventional therapy (diuretics, angiotensin-converting enzyme inhibitors and beta-blockers). The management of diastolic heart failure is less well defined, but symptoms should be managed, ischaemia prevented and the underlying causes identified and treated. Nurse-directed, multidisciplinary intervention (including education of patient and family, social support, review of medication, dietary modification and weight monitoring) have resulted in improvements in event-free survival and quality of life.