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Congestive heart failure in the elderly: the Cardiovascular Health Study

Sunil T Mathew1, John S Gottdiener, Dalane Kitzman

  • 1Division of Cardiology, St. Francis Hospital, State University of New York at Stony Brook, Roslyn, NY 11576, USA.

The American Journal of Geriatric Cardiology
|March 11, 2004
PubMed

Insights

Diagnosing heart failure in older adults is challenging, especially when ejection fraction is normal. Coronary heart disease, blood pressure, and inflammation predict heart failure, impacting elderly outcomes.

Area of Science:

  • Gerontology
  • Cardiology
  • Public Health

Background:

  • Congestive heart failure (CHF) in the elderly is a significant public health concern.
  • Clinical diagnosis of CHF in older adults can be difficult, particularly in cases with preserved ejection fraction (diastolic heart failure).
  • Existing research often focuses on younger populations with systolic heart failure, leaving a gap in understanding and treating CHF in the elderly.

Purpose of the Study:

  • To identify common predictors and substrates for heart failure in the elderly, encompassing both decreased and normal ejection fraction.
  • To investigate the prognostic implications of diastolic heart failure and reduced ejection fraction without heart failure in community-dwelling elderly individuals.
  • To highlight the need for further research into appropriate therapies for heart failure in the elderly population.

Main Methods:

  • Analysis of data from the Cardiovascular Health Study.
  • Identification of predictors for heart failure, including coronary heart disease, systolic blood pressure, and C-reactive protein (inflammation).
  • Assessment of left atrial size and atrial natriuretic peptide levels as markers in elderly patients with heart failure.

Main Results:

  • Coronary heart disease, elevated systolic blood pressure, and C-reactive protein are independent predictors of heart failure, regardless of ejection fraction.
  • Increased left atrial size and atrial natriuretic peptide are observed in both systolic and diastolic heart failure in the elderly.
  • Elderly individuals with reduced ejection fraction but no heart failure face a similar mortality risk as those with diastolic heart failure.

Conclusions:

  • Heart failure in the elderly, whether systolic or diastolic, carries a poor prognosis.
  • Predictors like coronary heart disease, blood pressure, and inflammation are crucial in identifying heart failure risk in older adults.
  • Further clinical trials are essential to determine optimal therapeutic strategies for heart failure in the elderly, considering the distinct pathophysiological profiles.

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