Drug treatment of chronic heart failure in the elderly.
ABSTRACT Congestive heart failure is a growing public health problem worldwide, particularly in the elderly population, in whom it has a substantial impact on quality of life and survival. Despite the fact that heart failure is the most common reason for hospitalisation over the age of 65 years, most clinical trials have excluded the elderly population. This is unfortunate because it may not be generally assumed that elderly patients are similar to younger ones. Nonspecific symptoms and co-morbidities in the elderly may make diagnosis of heart failure difficult. In addition, physiology changes with age, polypharmacy complicates therapy and the aim of therapy may change in the presence of co-morbidities such as cancer or dementia. Furthermore, drug interactions and adverse effects are frequent in heart failure in general, but increase significantly with age. Nevertheless, there is little evidence that treatment of heart failure should be fundamentally different in elderly patients compared with younger patients, although careful monitoring of medical therapy is of particular importance in elderly heart failure patients. Therefore, general guidelines on diagnosis and therapy of heart failure also apply to elderly patients, but therapy may need to be adjusted to cater for individual needs, potential interactions and altered elimination of drugs. This article summarises the evidence available for treatment in elderly patients with heart failure, discusses potential differences in elderly subjects compared with their younger counterparts and provides recommendations for clinical practice.
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ABSTRACT: AimsNT-proBNP-guided therapy results in intensification of medical heart failure (HF) therapy and is suggested to improve outcome. However, it is feared that an intensified, NT-proBNP-guided therapy carries a risk of adverse effects. Therefore, the safety and tolerability of NT-proBNP-guided therapy in the Trial of Intensified vs standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) was assessed.Methods and resultsA total of 495 chronic HF patients, aged ≥60, with an LVEF ≤45%, NYHA class ≥II, randomized to NT-proBNP-guided or symptom-guided therapy and ≥1 month follow-up were included in the present safety analysis. All adverse events (AEs) were recorded during the 18-month trial period. A total of 5212 AEs were noted, 433 of them serious. NT-proBNP-guided therapy led to a higher up-titration of HF medication and was well tolerated, with a dropout rate (12% vs. 11%, P = 1.0) and AE profile [number of AEs/patient-year 4.7 (2.8–9.4) vs. 5.4 (2.7–11.4), P = 0.69; number of severe AEs/patient-year 0.7 (0–2.7) vs. 1.3 (0–3.9), P = 0.21] similar to that of symptom-guided therapy, although most subjects in both treatment groups (96% vs. 95%, P = 0.55) experienced at least one AE. Age and number of co-morbidities were associated with AEs and interacted with the safety profile of NT-proBNP-guided therapy: positive effects were more frequent in younger and less co-morbid patients whereas potential negative effects—although small and related to non-severe AEs only—were only seen in the older and more co-morbid patients.ConclusionsNT-proBNP-guided therapy is safe in elderly and highly co-morbid HF patients.Trial registrationISRCTN43596477European Journal of Heart Failure 08/2013; 15(8):910-918. DOI:10.1093/eurjhf/hft079 · 6.58 Impact Factor
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ABSTRACT: Objective To assess heart failure prevalence, epidemiology, co-morbidities and polypharmacy in our region from electronic patient records. To evaluate gender differences in heart failure patients.Atención Primaria 02/2011; 43(2):61-67. DOI:10.1016/j.aprim.2010.03.021 · 0.89 Impact Factor
- Value in Health 05/2005; 8(3):269-270. DOI:10.1016/S1098-3015(10)62671-X · 2.89 Impact Factor