scholarly journals Treatment of heart failure in the elderly: Which drugs are essential and which should be avoided

2018 ◽  
Vol 88 (2) ◽  
Author(s):  
Giampaolo Scorcu ◽  
Annarita Pilleri
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
Patient Adherence ◽  
Adult Population ◽  
The Elderly ◽  
New Drugs ◽  
Common Disease ◽  
Current Guideline ◽  
Traditional Use ◽  
Positive Effects

With improved health care and with population aging, heart failure (HF) has become a common disease among the elderly and is one of the principal causes of mortality in elderly age. But the pharmacological management of HF in the elderly has still not yet been defined, as the clinical context is complicated by comorbidities, and differs from that of younger adults. In general, elderly patients with HF should be treated according to current guideline recommendations, for which ACE-I, beta-blockers and anti-aldosterones constitute the cornerstone of therapy. Interesting prospects are opening up with the use of new drugs such as neprilysin inhibitors, which appear to reproduce in the elderly the positive effects observed in the young adult population, and ivabradine, which may substitute the traditional use (now probably obsolete) of digitalis. Currently, however, treatment of HF in elderly patients is characterized by insufficient drug titration and by a habitual underuse of the recommended therapies – this is partly due to prescription inertia and in part to the negative effect of polypharmacotherapy on patient adherence. Even if HF therapy is similar in older and younger patients, the presence in older patients of more comorbidities, and frailty, functional status, and socio-environmental factors related to aging require a multidisciplinary approach to care and, above all, an additional assessment aimed at personalizing the treatment.

106 Precipitating factors in the elderly patients admitted with the diagnosis of heart failure. Are easy to find?

2006 ◽  
Vol 5 (1) ◽  
pp. 25-26
Author(s):  
R VIDALPEREZ ◽  
E ABUASSI ◽  
M PARAMODEVEGA ◽  
P VELOSO ◽  
A VARELAROMAN ◽  
...  
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
The Elderly ◽  
Precipitating Factors

HYPERTENSION IN ELDERLY:OUR CURRENT TRENDS

2021 ◽  
pp. 56-57
Author(s):  
Rohit Arora ◽  
D.K Sharma
Keyword(s):  
Blood Pressure ◽  
Elderly Patients ◽  
The Elderly ◽  
Common Disease ◽  
Old Patients ◽  
Current Trends ◽  
Increased Risk ◽  
Individualized Approach ◽  
Risk Of Falls ◽  
Optimal Target

Hypertension is a common disease in the elderly associated with signicant morbidity and mortality. Due to the complexity of this population, the optimal target of blood pressure (BP) control is still controversial. In this article, we conduct a literature review of trials published in English in the last 10 years which were specically designed to study the efcacy and safety of various BP targets in patients who are 70 years or older. Using these criteria, we found that the benets in the positive studies were demonstrated even with a minimal BPcontrol (systolic BP[SBP] <150 mmHg) and continued to be reported for a SBP<120 mmHg. On the other hand, keeping SBP<140 mmHg seemed to be safely achieved in elderly patients. Although the safety of lowering SBP to <120 mmHg is debated, Systolic Blood Pressure Intervention Trial study has shown no increased risk of falls, fractures, or kidney failure in elderly patients with SBP lower than this threshold. While the recent guidelines recommended to keep BP <130/80 mmHg in the elderly, more individualized approach should be considered to achieve this goal in order to avoid undesirable complications. Furthermore, further studies are required to evaluate BPtarget in very old patients or those with multiple comorbidities.

Thiamine level in the elderly patients with heart failure

2004 ◽  
Vol 10 (5) ◽  
pp. S172
Author(s):  
Terada Hajime ◽  
Katoh Hideki ◽  
Satoh Hiroshi ◽  
Hayashi Hideharu
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
The Elderly ◽  
Patients With Heart Failure ◽  
Thiamine Level

scholarly journals Целевой уровень артериального давления при лечении артериальной гипертензии у пациентов пожилого возраста с хронической сердечной недостаточностью

2019 ◽  
pp. 8-16
Author(s):  
M.S. CHERNIAEVA ◽  
O.D. OSTROUMOVA
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Cardiovascular Events ◽  
The Elderly ◽  
Target Blood Pressure ◽  
Lower Systolic Blood Pressure ◽  
Reduced Ejection Fraction ◽  
Increased Risk

Высокая распространенность хронической сердечной недостаточности (ХСН) в популяции пожилых пациентов наряду с устойчивым ро- стом численности пожилого населения как в России, так и в западных странах все больше привлекает внимание врачей к проблеме, связан- ной с ведением данного заболевания. Известно, что ведущим фактором риска развития ХСН является повышенное артериальное давление (АД) и большинство пациентов с ХСН имеют в анамнезе артериальную гипертонию (АГ), поэтому лечение пациентов пожилого возраста c АГ и ХСН является одним из важных направлений в профилактике прогрессирования ХСН, снижения количества госпитализаций и смерт- ности. Лечение АГ у пожилых имеет свои особенности, связанные с функциональным статусом пациентов и их способностью переносить лечение. В европейских рекомендациях (2018) пересмотрены целевые цифры АД при лечении АГ у пожилых, однако данные по целевым цифрам АД для лечения АГ у пациентов с ХСН опираются лишь на исследования, проводившиеся у больных без ХСН. Данные об оптималь- ном целевом уровне у пациентов с АГ и ХСН представлены в единичных исследованиях. В настоящей статье проанализирована взаимосвязь уровня АД и сердечно-сосудистых событий и смертности отдельно для пациентов с АГ и сердечной недостаточностью с низкой фракцией выброса левого желудочка и с сохраненной фракцией выброса левого желудочка. Результаты многих исследований показывают, что более низкий уровень систолического АД (120 мм рт. ст.) и диастолического АД (80 мм рт. ст.) ассоциирован с развитием неблагоприятных сердечно-сосудистых событий, особенно у пациентов с сердечной недостаточностью с низкой фракцией выброса левого желудочка.The high prevalence of chronic heart failure (CHF) in the elderly patients, along with the steady growth of the elderly population, both in Russia and in Western countries, is increasingly attracting the attention of doctors to the problem associated with the management of this disease. It is known that the leading risk factor for CHF is high blood pressure (BP) and most patients with CHF have a history of hypertension (H), so the treatment of elderly patients with H and CHF is the major focus in the slowing CHF progression, reducing the heart failure hospitalisation and mortality. Treatment of hypertension in the elderly has some specific features associated with the functional status of patients and their ability to tolerate treatment. The European recommendations (2018) revised target blood pressure levels in the elderly patients, however, data on target blood pressure levels in patients with CHF are based only on studies conducted in patients without CHF, data on the optimal target blood pressure levels in patients with hypertension and CHF are presented in single studies. In this article we analyze the relationship between blood pressure levels and cardiovascular events and mortality separately for patients with hypertension and heart failure with reduced ejection fraction and with preserved ejection fraction. Several studies show that lower systolic blood pressure (120 mm Hg) and diastolic blood pressure (80 mm Hg) is associated with the increased risk of cardiovascular events, especially in patients with heart failure with reduced ejection fraction.

scholarly journals The Correlation between Gut Microbiota and Serum Metabolomic in Elderly Patients with Chronic Heart Failure

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Zhenhua Wang ◽  
Zhaoling Cai ◽  
Markus W. Ferrari ◽  
Yilong Liu ◽  
Chengyi Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Gut Microbiota ◽  
Elderly Patients ◽  
16S Rdna ◽  
Healthy Subjects ◽  
The Elderly ◽  
Inflammatory Factors ◽  
16S Rdna Sequencing ◽  
Rdna Sequencing

Objective. Chronic heart failure (CHF) refers to a state of persistent heart failure that can be stable, deteriorated, or decompensated. The mechanism and pathogenesis of myocardial remodeling remain unknown. Based on 16S rDNA sequencing and metabolomics technology, this study analyzed the gut microbiota and serum metabolome in elderly patients with CHF to provide new insights into the microbiota and metabolic phenotypes of CHF. Methods. Blood and fecal samples were collected from 25 elderly patients with CHF and 25 healthy subjects. The expression of inflammatory factors in blood was detected by ELISA. 16S rDNA sequencing was used to analyze the changes in microorganisms in the samples. The changes of small molecular metabolites in serum samples were analyzed by LC-MS/MS. Spearman correlation coefficients were used to analyze the correlation between gut microbiota and serum metabolites. Results. Our results showed that the IL-6, IL-8, and TNF-α levels were significantly increased, and the IL-10 level was significantly decreased in the elderly patients with CHF compared with the healthy subjects. The diversity of the gut microbiota was decreased in the elderly patients with CHF. Moreover, Escherichia Shigella was negatively correlated with biocytin and RIBOFLAVIN. Haemophilus was negatively correlated with alpha-lactose, cellobiose, isomaltose, lactose, melibiose, sucrose, trehalose, and turanose. Klebsiella was positively correlated with bilirubin and ethylsalicylate. Klebsiella was negatively correlated with citramalate, hexanoylcarnitine, inosine, isovalerylcarnitine, methylmalonate, and riboflavin. Conclusion. The gut microbiota is simplified by the disease, and serum small-molecule metabolites evidently change in elderly patients with CHF. Serum and fecal biomarkers could be used for elderly patients with CHF screening.

Abstract 15469: Malnutrition and Cognitive Dysfunction in the Elderly Patients With Acute Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michiaki NAGAI ◽  
Keigo Dote ◽  
Masaya Kato ◽  
Noboru Oda ◽  
Eiji Kunita ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Cognitive Dysfunction ◽  
Mmse Score ◽  
The Elderly ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Stable Phase ◽  
Conut Score

Introduction: Malnutrition, cognitive decline and heart failure (HF) frequently coexist in the elderly. A recent systematic review revealed that malnutrition was a possible contributing factor of cognitive impairment. Although several studies reported the association of malnutrition with poor HF prognosis, the underlying pathophysiology has been unclear. Hypothesis: We assessed the hypothesis that malnutritional status might be associated with cognitive dysfunction in the elderly with HF. In addition, we investigated whether left ventricular ejection fraction (LVEF) moderates that relationship or not. Methods: Nutritional status and cognitive function were evaluated using the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score and mini-mental state examination (MMSE) in 245 elderly inpatients in stable phase of HF (82.9±6.0 years old, male 49.4%). Echocardiography was performed at admission. HF with preserved EF (HFpEF) was defined according to LVEF more than 50% (n=129). Results: According to the quartile of MMSE score (< 19, ≥19 to 27≤, >27), significant associations of MMSE score were observed with GNRI (89.1 vs 95.4 vs 95.5, p=0.004) and CONUT score (3.50 vs 2.71 vs 2.61, p=0.039) among three groups. In the logistic regression analysis adjusted for the confounders including age, gender, LVEF, brain natriuretic peptide level, systolic blood pressure at admission, diuretics and antihypertensive medication use, GNRI (β=0.96, 95%CI:0.93 to 0.99, p=0.008) and CONUT score (β=1.18, 95%CI:1.01 to 1.37, p=0.03) each was significantly associated with cognitive dysfunction (defined as MMSE score <19). According to the HF phenotype, GNRI (β=0.93, 95%CI:0.88 to 0.98, p=0.01) and CONUT (β=1.55, 95%CI:1.19 to 2.02, p=0.001) each had a significant relationship with cognitive dysfunction only in the group without HFpEF. Conclusions: In conclusion , lower GNRI and higher CONUT score were shown to be significant indicators of cognitive dysfunction in the elderly HF patients. These results highlight the importance of stratifying by nutritional status for a clinical intervention of cognitive dysfunction in the elderly patients without HFpEF.

Balancing the Efficacy and Tolerability of First-line Treatment in Elderly Myeloma Patients

2010 ◽  
Vol 00 (04) ◽  
pp. 85
Author(s):  
Valeria Magarotto ◽  
Antonio Palumbo ◽  
◽  
Keyword(s):  
Elderly Patients ◽  
Elderly Population ◽  
The Elderly ◽  
New Drugs ◽  
High Dose ◽  
Standard Drug ◽  
High Dose Dexamethasone ◽  
Life Threatening ◽  
Choice Of Therapy

Multiple myeloma (MM) is the second most frequent malignancy of the blood. It is more common among the elderly population, with <28% of patients 65–74 years of age and 37% >75 years of age. Before the introduction of novel agents, melphalan and prednisone (MP) was the best treatment for patients not eligible for autologous stem cell transplantation (ASCT). Steroids provide other options but with a higher toxicity, especially in elderly patients. Currently, the association of thalidomide with MP (MPT) represents the gold standard of treatment for patients ineligible for ASCT. Bortezomib and lenalidomide associated with MP provided effective and safe alternatives. High-dose dexamethasone combined with the new drugs is effective, but very toxic for elderly patients. Trials that combine low-dose dexamethasone with thalidomide, lenalidomide and bortezomib plus other agents such as doxorubicin and cyclophosphamide are ongoing. The role of transplantation is controversial in myeloma patients >65 years of age because elderly patients are fragile and the choice of therapy must take into account the likelihood of co-morbidities. Reducing the dose of the standard drug – eventually prolonging the duration of the treatment and administering prophylaxis – allows effective treatment of MM, without important or life-threatening toxicities.

Use of Benzodiazepines and Z-Drugs in the Geriatric Population

2020 ◽  
pp. 41-67
Author(s):  
Jan M. Kitzen
Keyword(s):  
Elderly Patients ◽  
Behavioral Therapy ◽  
Adult Population ◽  
Large Body ◽  
The Elderly ◽  
Hepatic Function ◽  
Potentially Inappropriate Medications ◽  
Geriatric Population ◽  
Nervous System Function ◽  
Balance Functions

The benzodiazepine (BZD) class of drugs has proven to be a useful addition to therapeutic management of anxiety and sleep disorders in the adult population. However, after many years of experience with BZDs in elderly patients (≥65 years), a large body of evidence indicates that BZDs are no longer recommended for use in this segment of the population, except under special conditions. Several aging-related changes in physiology such as decreases in renal and hepatic function, altered central nervous system function and changes in body composition can lead to impaired excretion of drug, higher plasma levels and accumulation of these drugs in the body. Side effects such as sedation, dizziness, cognitive impairment, and diminished control of gait and balance functions place the elderly at greater risk of various adverse events, especially falls and fractures, compared to younger adults. Another class of drugs, known as Z-drugs is structurally dissimilar from the BZDs but able to bind to GABAA, receptors making them useful for management of insomnia. These drugs have also been found to pose significant hazards to the elderly and are also not recommended for use in elderly patients. Both of these classes of drugs are currently included in the AGS Beers Criteria® of potentially inappropriate medications for use in the elderly. Alternative pharmacologic approaches to managing these conditions include use of either serotonin-norepinephrine reuptake inhibitors or buspirone for anxiety and the use of either low doses of doxepin, melatonin, or the melatonin agonist ramelteon for management of insomnia. Cognitive behavioral therapy and other relaxation techniques offer non-pharmacologic approaches to managing these conditions, thereby decreasing the need for prescribing BZDs or Z-drugs in the elderly.

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