[Particular aspects of heart failure in elderly patients]

The prognosis of heart failure in elderly patients is poor. The knowledge of the particular aspects of this pathology could certainly increase the prevention and the therapeutic approach of this disease. The presence of many precipitating factors and comorbidities is typical of this pathology. The clinical diagnosis is particularly difficult, especially because the signs and symptoms are similar to those of frequent disorders in elderly patients. Moreover, cognition and sensory impairments and the spontaneous reduction of the physical activity, masking symptoms, may also disturb the diagnosis. Diastolic heart failure, frequent in old patients, contributes sometimes to perturb the diagnosis. The treatment of heart failure in elderly people is based in first line on the control of the precipitating factors. The pharmacotherapy is not fundamentally different from the younger patient and must follow the recommendations of the literature (Evidence Based Medicine). The underutilization of proven therapy must indeed be avoided. However, the careful beginning, at very low doses, and a careful titration to obtain the recommended doses, is essential. Moreover, the susceptibility to side effects and the frequent contra-indications in the elderly require meticulous precautions in the prescription of the drugs. Diuretics remain the cornerstone to promptly control the pulmonary congestion and the edema. The angiotensin-converting-enzyme inhibitors, the antagonists of the angiotensin-receptors and the beta-blockers must be prescribed as in the younger patients. Digoxin plays also a role in several precise indications. Coronary angioplasty, heart surgery and technique of resynchronization have indications in certain cases. Multidisciplinary approach and vigilant follow-up are essential to improve the prognostic of heart failure in elderly patients.