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Heart failure with preserved ejection fraction in the elderly: scope of the problem
Bharathi Upadhya1, George E Taffet2, Che Ping Cheng1
1Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Journal of Molecular and Cellular Cardiology
|March 11, 2015
Summary
Heart failure with preserved ejection fraction (HFpEF) is common in older adults. This geriatric syndrome involves multiple organ systems and comorbidities, impacting treatment strategies.
Area of Science:
- Geriatric Medicine
- Cardiovascular Medicine
- Internal Medicine
Background:
- Heart failure with preserved ejection fraction (HFpEF) is the predominant HF type in aging populations, especially women.
- HFpEF presents significant morbidity and mortality, comparable to HF with reduced ejection fraction, posing challenges for clinicians and researchers.
- Emerging evidence suggests HFpEF involves systemic issues beyond diastolic dysfunction, affecting multiple organ systems.
Purpose of the Study:
- To reframe understanding of HFpEF as a geriatric syndrome.
- To explore the multi-factorial pathophysiology and clinical heterogeneity of HFpEF.
- To identify new avenues for research and management strategies.
Main Methods:
- Review of current literature on HFpEF pathophysiology and clinical presentation.
- Analysis of age-related changes, comorbidities, and systemic effects in HFpEF.
- Synthesis of insights from clinical trials and observational studies.
Main Results:
- HFpEF is characterized by reduced reserve capacity across multiple organ systems, driven by aging, comorbidities, and the condition itself.
- Comorbidities are key predictors of outcomes, and non-cardiovascular events constitute a significant portion of clinical events in HFpEF.
- Past clinical drug trials have largely failed to meet primary outcome targets.
Conclusions:
- Viewing HFpEF as a geriatric syndrome with complex, multifactorial pathophysiology is crucial.
- Recognizing the clinical heterogeneity and systemic nature of HFpEF can unlock new mechanistic insights.
- This perspective may pave the way for improved management and therapeutic advancements in HFpEF.
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