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Int J Angiol 2022; 31(04): 251-259
DOI: 10.1055/s-0042-1758357
Invited Article

Pathophysiology and Management of Heart Failure in the Elderly

Nakeya Dewaswala
1   Department of Cardiovascular Diseases, University of Kentucky, Lexington, Kentucky
,
Vinayak Mishra 
2   Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
,
Huzefa Bhopalwala
3   Department of Internal Medicine, Appalachian Regional Healthcare, Whitesburg, Kentucky
,
Abdul Khan Minhas
4   Department of Internal Medicine, Forrest General Hospital, Hattiesburg, Mississippi
,
Suresh Keshavamurthy
5   Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
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Abstract

The population of elderly adults is increasing globally. It has been projected that the population of adults aged 65 years will increase by approximately 80% by 2050 in the United States. Similarly, the elderly population is rising in other countries; a notable example being Japan where approximately 30% of the population are aged above 65 years. The pathophysiology and management of heart failure (HF) in this age group tend to have more intricacies than in younger age groups owing to the presence of multiple comorbidities. The normal aging biology includes progressive disruption at cellular and genetic levels and changes in molecular signaling and mechanical activities that contribute to myocardial abnormalities. Older adults with HF secondary to ischemic or valvular heart disease may benefit from surgical therapy, valve replacement or repair for valvular heart disease and coronary artery bypass grafting for coronary artery disease. While referring these patients for surgery, patient and family expectations and life expectations should be taken into account. In this review, we will cover the pathophysiology and the management of HF in the elderly, specifically discussing important geriatric domains such as frailty, cognitive impairment, delirium, polypharmacy, and multimorbidity.

Keywords

cardiac output - heart failure - elderly - myocardium - frailty - polypharmacy - cardiac transplantation


Publication History

Article published online:
11 November 2022

© 2022. International College of Angiology. This article is published by Thieme.

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