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
