Diastolic heart failure: a difficult problem in the elderly

Heart failure with normal systolic function has been equated to diastolic heart failure (DHF). DHF appears to be quite common in the elderly, especially in elderly women with hypertension. Recent epidemiologic studies suggest that 30%-50% of patients with heart failure may have DHF. Morbidity for DHF is considerable and comparable to that of heart failure with left ventricular systolic dysfunction. Both groups of patients have similar rates of recurrent hospitalization and cost of care. Long-term mortality also appears to be similar in the two groups of patients. With the aging of the population, the numbers of patients with DHF will continue to rise and are likely to contribute significantly to the burden of disease caused by heart failure. Unfortunately, as yet, no reliable definition has been found for DHF. Currently the diagnosis of DHF is often made by exclusion, and treatment is empirical and unsatisfactory because of the lack of large-scale, randomized, controlled trials in this area; however, several large and other smaller trials are currently in progress that will hopefully provide some answers.