[Quality of care and management programs for the elderly with heart failure]

The majority of patients with heart failure are elderly. In order to point out the clinical characteristics and the quality of care of elderly heart failure patients we evaluated available data from national databases and observational studies. Elderly patients have more severe clinical manifestations, multiple etiologies and comorbid diseases, frequent hospital admissions, and a worse prognosis. As many as 30-50% of elderly patients with heart failure may have normal systolic function. In the elderly, evidence-based treatments are relatively underused with often inappropriately low doses. However, this "underuse" largely depends on the higher "frailty" of these patients (i.e. multiple coexisting diseases, disability, socio-environmental factors) and the lack of definite evidence on efficacy and safety of treatments in the very elderly. Several studies have documented the efficacy of specialized multidisciplinary heart failure disease management programs in terms of reducing hospital utilization, improving quality of life, functional capacity, patient satisfaction, compliance with diet and medications, and decreasing cost of care. Thus, there are opportunities to improve quality in many aspects of care, such as instrumental and multidimensional assessment and out-of-hospital management. Targeted clinical trials and rigorous observational studies with the aim at favoring the implementation of specific guidelines into clinical practice and continuity of care in the elderly are needed.