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Treatment of congestive heart failure in older persons
1Hebrew Hospital Home, Bronx, New York 10475, USA.
Insights
This review focuses on managing congestive heart failure (CHF) in older adults. Key recommendations include measuring left ventricular ejection fraction (LVEF) and tailoring treatments based on LVEF results.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) is a significant health concern, particularly in the aging population.
- Effective management strategies are crucial to improve outcomes and quality of life for older adults with CHF.
Purpose of the Study:
- To review current management approaches for congestive heart failure (CHF).
- To emphasize treatment considerations specific to older adults with CHF.
Main Methods:
- A comprehensive literature search of the MEDLINE database was conducted.
- Studies focusing on CHF management in older individuals and recent research were prioritized for review.
Main Results:
- Treatment protocols for CHF in older adults vary based on left ventricular ejection fraction (LVEF).
- Recommendations include lifestyle modifications (low sodium diet), diuretics, ACE inhibitors, and specific drug additions (digoxin, isosorbide dinitrate/hydralazine, beta blockers) based on persistence of symptoms.
- Calcium channel blockers are not recommended for CHF in older adults; their role in specific conditions is under investigation.
Conclusions:
- Measurement of LVEF is essential for all older adults diagnosed with CHF.
- Treatment should address underlying and precipitating causes of CHF.
- Therapeutic regimens should be individualized based on LVEF and patient response, with specific guidance on medication sequencing and contraindications.
Objective:
To review the management of congestive heart failure (CHF), with emphasis on older adults.
Data Sources:
A computer-assisted search of the English language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.
Study Selection:
Studies on the management of CHF were screened for review. Studies in older people and recent studies were emphasized.
Data Extraction:
Pertinent data were extracted from the reviewed articles. Emphasis was on studies involving the older persons. Relevant articles were reviewed in depth.
Data Synthesis:
Available data about the management of CHF, with emphasis on studies involving older people, were summarized.
Conclusions:
Left ventricular ejection fraction (LVEF) should be measured in all older persons with CHF. Underlying causes of CHF should be treated when possible. Precipitating causes of CHF should be treated. Older persons with CHF associated with an abnormal LVEF should be treated with a low sodium diet and with diuretics plus angiotensin-converting enzyme (ACE) inhibitors. If CHF persists, digoxin should be added to the therapeutic regimen. If CHF still persists, isosorbide dinitrate plus hydralazine should be added. If CHF still persists, a beta blocker should also be used. Calcium channel blockers should not be used. Older persons with CHF associated with a normal LVEF should be treated with a low sodium diet and with diuretics plus ACE inhibitors. If CHF persists, a beta blocker or isosorbide dinitrate plus hydralazine or a calcium channel blocker should be added to the therapeutic regimen. If sinus rhythm is present, digoxin should not be used. The role of angiotensin II receptor antagonists such as losartan in the treatment of CHF is under investigation.