Drug Treatment of Chronic Heart Failure in the Elderly
Cardiology, University Hospital Basel, Basel, Switzerland. Drugs & Aging
(Impact Factor: 2.84).
02/2007; 24(12):991-1006. DOI: 10.2165/00002512-200724120-00003
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.
Available from: Erich Kasper
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ABSTRACT: An overview about current status of SiGe-HBT production is given. Advanced SiGe-HBTs are predicted to reach in near future fT=200 GHz. Design examples are given.
Available from: Marvin Shepherd
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ABSTRACT: The aim of this study was to assess whether heart failure (HF) could be a risk factor for adverse drug reactions (ADRs) among hospitalized older adults. This study included 19,496 patients admitted to community- and university-based hospitals in Italy (mean age 70 +/- 14 years; 49.7% female). ADRs were identified in 207 of the 2,413 (8.6%) patients with HF and in 855 (5.0%) of the 17,083 patients without HF (P < 0.001). After adjusting for potential confounders, HF was shown to be associated with an increased likelihood of experiencing an ADR (odds ratio (OR) 1.29; 95% confidence interval (CI) 1.06-1.56). After stratifying the sample by gender, the association continued to be seen in the women (OR 1.58; 95% CI 1.22-2.05) but not in the men (OR 0.99; 95% CI 0.74-1.34). In conclusion, HF appears to be associated with a higher rate of ADRs among hospitalized patients. Gender may influence the effect of HF on the risk of ADRs.
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