Lo scompenso cardiaco nell'anziano

Translated title of the contribution: Heart failure in elderly subjects

F. Rengo, D. Acanfora, L. Trojano, D. F. Vitale, C. Rengo, G. Furgi, C. Picone, G. L. Iannuzzi, N. Ferrara

Research output: Contribution to journalArticlepeer-review

Abstract

The annual incidence of heart failure in elderly subjects, aged ≤ 75 years, is 13 to 50/1000 subjects, while it is 1.6/1000 in people aged 45-54 years. The prevalence of heart failure is about 3% in subjects aged 45-64 years, 6% in those older than 65 years and 10% in subjects aged more than 75 years. These data were confirmed by our population based study, in 'Osservatorio Geriatrico Campano' (Geriatric Observation Study in the Campania Region, Italy). The mortality rate for congestive heart failure is high and increases with age. The etiology of congestive heart failure is similar in the elderly and in middle-aged patients. However, several anatomo-functional, hormonal and autonomic nervous system changes, typical of congestive heart failure, also occur during normal aging. These findings may explain the dramatic evolution of congestive heart failure in elderly patients. Moreover, some features of elderly - e.g. comorbid disease, atypical clinical presentations, loss of autonomy, increased risks of iatrogenic disorders should be considered. In a recent multicentric study on heart failure in the elderly (CHF Italian Study I), we found that the prevalence of heart failure was 49.3% in hospitalized cardiac patients aged 65-74 years and 66.3% in those aged ≤ 75 years. In our study, hypertensive cardiopathy, (40.1%) and ischemic heart disease (37.8%) were the most frequent heart diseases, but the former was associated with low risk factors for heart failure [(+ 2%) RR = 1.02; CI 95%: 0.92-1.12; P = NS]. In our population, about 19.6% patients presented two or more comorbid cardiac disease. The presence and number of chronic illnesses can modify the risk profile for heart failure in elderly patients. A significant correlation between the number of associated chronic disease and the presence of congestive heart failure was found. The association of chronic illnesses and congestive heart failure tends to lead to loss of autonomy. Deterioration of cognitive functions, depression and physical dependence appear to be independent factors for the risk of congestive heart failure. In elderly patients clinical manifestations of congestive heart failure may be difficult to interpret. The prognosis for congestive heart failure is very poor in the elderly. The mortality rate is extremely high: 82% in men (RR = 4.0) and 67% in women (RR = 5.8) within 6 years after the onset of the syndrome, i.e. 4 to 8 time higher than the age-matched population. The rate of mortality 30 days after the onset of clinical manifestations of congestive heart failure is about 20% in men and women. Sudden death is the most common cause of exitus. During an ongoing 3 year follow up on 128 patients, aged ≤ 75 years, with cardiac failure of different etiology and reduced ejection fraction of the left ventricle (<45%), we found that 44 patients had died (44%); sudden death was associated with 36 (82%). Ten clinical variables identified at the start of the study, showed prognostic value: presence of a third cardiac sound, ≤ 3 clinical signs, left ventricular ejection fraction ≤ 25%, NYHA class ≤ III, dyspnoea, digoxin administration, pulmonary rales, ≤ 4 symptoms, asthenia and associated pulmonary diseases. Short-term mortality rate was also high. The mortality rate during hospitalization of the patients enrolled in the CHF Italian Study I was 22.7%, without any significant differences in age groups (65-74 = 23.8%, ≤ 75 years = 21.9). Heart failure was the most frequent cause of death (26.4%), particularly in the older patients (65-74 years = 14.5%, ≤ 75 years = 36.4%). Since no specific drugs exist for the pharmacologic treatment of heart failure in the elderly, treatment of heart failure depends on drug choice and dosage, so as to obtain the best results with the fewest side effects. The multietiologic character of congestive heart failure, comorbid disease, the loss of autonomy and the deterioration of cognitive functions suggest the need for a multidimensional approach and continuous intervention in the elderly patients with heart disease, in particular, those with congestive heart failure.

Translated title of the contributionHeart failure in elderly subjects
Original languageItalian
Pages (from-to)197-217
Number of pages21
JournalGiornale di Gerontologia
Volume44
Issue number3
Publication statusPublished - 1996

ASJC Scopus subject areas

  • Ageing
  • Geriatrics and Gerontology

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