Drugs & Aging

, Volume 24, Issue 12, pp 991–1006 | Cite as

Drug Treatment of Chronic Heart Failure in the Elderly

  • Gregor Leibundgut
  • Matthias Pfisterer
  • Hans-Peter Brunner-La Rocca
Therapy In Practice

Abstract

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.

Keywords

Heart Failure Elderly Patient Cardiac Resynchronisation Therapy Carvedilol Calcium Channel Antagonist 

Notes

Acknowledgements

No sources of funding were used to assist in the preparation of this article. Dr Brunner-La Rocca has acted as a consultant for and/or received lecture fees from Menarini, Novartis, Servier, AstraZeneca and Pfizer. The other authors have no conflicts of interest that are directly relevant to the content of this article.

References

  1. 1.
    Swedberg K, Cleland J, Dargie H, et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005). The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J 2005; 26: 1115–40PubMedCrossRefGoogle Scholar
  2. 2.
    Puggaard L. Age-related decline in maximal oxygen capacity: consequences for performance of everyday activities. J Am Geriatr Soc 2005; 53: 546–7PubMedCrossRefGoogle Scholar
  3. 3.
    Morgan S, Smith H, Simpson I, et al. Prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in general practice setting: cross sectional survey. BMJ 1999; 318: 368–72PubMedCrossRefGoogle Scholar
  4. 4.
    Wang CS, FitzGerald JM, Schulzer M, et al. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA 2005; 294: 1944–56PubMedCrossRefGoogle Scholar
  5. 5.
    Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Writing Committee to update the 2001 guidelines for the evaluation and management of heart failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005; 112: el54–235CrossRefGoogle Scholar
  6. 6.
    Muntwyler J, Abetel G, Gruner C, et al. One-year mortality among unselected outpatients with heart failure. Eur Heart J 2002; 23: 1861–6PubMedCrossRefGoogle Scholar
  7. 7.
    Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics: 2006 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006; 113: e85–151PubMedCrossRefGoogle Scholar
  8. 8.
    Kupari M, Lindroos M, Iivanainen AM, et al. Congestive heart failure in old age: prevalence, mechanisms and 4-year prognosis in the Helsinki Ageing Study. J Intern Med 1997; 241: 387–94PubMedCrossRefGoogle Scholar
  9. 9.
    Masoudi FA, Havranek EP, Krumholz HM. The burden of chronic congestive heart failure in older persons: magnitude and implications for policy and research. Heart Fail Rev 2002; 7: 9–16PubMedCrossRefGoogle Scholar
  10. 10.
    Massie BM, Shah NB. Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management. Am Heart J 1997; 133: 703–12PubMedCrossRefGoogle Scholar
  11. 11.
    Heiat A, Gross CP, Krumholz HM. Representation of the elderly, women, and minorities in heart failure clinical trials. Arch Intern Med 2002; 162: 1682–8PubMedCrossRefGoogle Scholar
  12. 12.
    Lien CT, Gillespie ND, Struthers AD, et al. Heart failure in frail elderly patients: diagnostic difficulties, co-morbidities, polypharmacy and treatment dilemmas. Eur J Heart Fail 2002; 4: 91–8PubMedCrossRefGoogle Scholar
  13. 13.
    MacIntyre K, Capewell S, Stewart S, et al. Evidence of improving prognosis in heart failure: trends in case fatality in 66 547 patients hospitalized between 1986 and 1995. Circulation 2000; 102: 1126–31PubMedCrossRefGoogle Scholar
  14. 14.
    Jong P, Vowinckel E, Liu PP, et al. Prognosis and determinants of survival in patients newly hospitalized for heart failure: a population-based study. Arch Intern Med 2002; 162: 1689–94PubMedCrossRefGoogle Scholar
  15. 15.
    Ponikowski P, Piepoli M, Chua TP, et al. The impact of cachexia on cardiorespiratory reflex control in chronic heart failure. Eur Heart J 1999; 20: 1667–75PubMedCrossRefGoogle Scholar
  16. 16.
    Pekkanen J, Nissinen A, Vartiainen E, et al. Changes in serum cholesterol level and mortality: a 30-year follow-up. The Finnish cohorts of the Seven Countries Study. Am J Epidemiol 1994; 139: 155–65PubMedGoogle Scholar
  17. 17.
    Bulpitt CJ. Secondary prevention of coronary heart disease in the elderly. Heart 2005; 91: 396–400PubMedCrossRefGoogle Scholar
  18. 18.
    Cheitlin MD. Cardiovascular physiology: changes with aging. Am J Geriatr Cardiol 2003; 12: 9–13PubMedCrossRefGoogle Scholar
  19. 19.
    Bozkurt B, Deswal A. Obesity as a prognostic factor in chronic symptomatic heart failure. Am Heart J 2005; 150: 1233–9PubMedCrossRefGoogle Scholar
  20. 20.
    Zuccala G, Onder G, Pedone C, et al. Hypotension and cognitive impairment: selective association in patients with heart failure. Neurology 2001; 57: 1986–92PubMedCrossRefGoogle Scholar
  21. 21.
    McGann PE. Comorbidity in heart failure in the elderly. Clin Geriatr Med 2000; 16: 631–48PubMedCrossRefGoogle Scholar
  22. 22.
    Williamson J, Chopin JM. Adverse reactions to prescribed drugs in the elderly: a multicentre investigation. Age Ageing 1980; 9: 73–80PubMedCrossRefGoogle Scholar
  23. 23.
    Hogg K, Swedberg K, McMurray J. Heart failure with preserved left ventricular systolic function; epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol 2004; 43: 317–27PubMedCrossRefGoogle Scholar
  24. 24.
    Masoudi FA, Havranek EP, Smith G, et al. Gender, age, and heart failure with preserved left ventricular systolic function. J Am Coll Cardiol 2003; 41: 217–23PubMedCrossRefGoogle Scholar
  25. 25.
    Adhiyaman V, Asghar M, Oke A, et al. Nephrotoxicity in the elderly due to co-prescription of angiotensin converting enzyme inhibitors and nonsteroidal anti-inflammatory drugs. J R Soc Med 2001; 94: 512–4PubMedGoogle Scholar
  26. 26.
    McAlister FA, Stewart S, Ferrua S, et al. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol 2004; 44: 810–9PubMedGoogle Scholar
  27. 27.
    Brunner-La Rocca HP, Buser PT, Schindler R, et al. Management of elderly patients with congestive heart failure: design of the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF). Am Heart J 2006; 151: 949–55PubMedCrossRefGoogle Scholar
  28. 28.
    Amabile CM, Spencer AP. Keeping your patient with heart failure safe: a review of potentially dangerous medications. Arch Intern Med 2004; 164: 709–20PubMedCrossRefGoogle Scholar
  29. 29.
    Burgess CL, Holman CD, Satti AG. Adverse drug reactions in older Australians, 1981–2002. Med J Aust 2005; 182: 267–70PubMedGoogle Scholar
  30. 30.
    Turnheim K. Drug therapy in the elderly. Exp Gerontol 2004; 39: 1731–8PubMedCrossRefGoogle Scholar
  31. 31.
    Shibata MC, Soneff CM, Tsuyuki RT. Utilization of evidence-based therapies for heart failure in the institutionalized elderly. Eur J Heart Fail 2005; 7: 1122–5PubMedCrossRefGoogle Scholar
  32. 32.
    Pfeffer MA, Swedberg K, Granger CB, et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003; 362: 759–66PubMedCrossRefGoogle Scholar
  33. 33.
    Baracskay D, Jarjoura D, Cugino A, et al. Geriatric renal function: estimating glomerular filtration in an ambulatory elderly population. Clin Nephrol 1997; 47: 222–8PubMedGoogle Scholar
  34. 34.
    Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31–41PubMedCrossRefGoogle Scholar
  35. 35.
    Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461–70PubMedGoogle Scholar
  36. 36.
    Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003; 139: 137–47PubMedGoogle Scholar
  37. 37.
    Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006; 355: 251–9PubMedCrossRefGoogle Scholar
  38. 38.
    Bursi F, Weston SA, Redfield MM, et al. Systolic and diastolic heart failure in the community. JAMA 2006; 296: 2209–16PubMedCrossRefGoogle Scholar
  39. 39.
    Fonarow GC, Yancy CW, Heywood JT. Adherence to heart failure quality-of-care indicators in US hospitals: analysis of the ADHERE Registry. Arch Intern Med 2005; 165: 1469–77PubMedCrossRefGoogle Scholar
  40. 40.
    Feinglass J, Martin GJ, Lin E, et al. Is heart failure survival improving? Evidence from 2323 elderly patients hospitalized between 1989 and 2000. Am Heart J 2003; 146: 111–4PubMedCrossRefGoogle Scholar
  41. 41.
    Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med 2004; 351: 543–51PubMedCrossRefGoogle Scholar
  42. 42.
    Ahmed A, Husain A, Love TE, et al. Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods. Eur Heart J 2006; 27: 1431–9PubMedCrossRefGoogle Scholar
  43. 43.
    van Kraaij DJ, Jansen RW, Sweep FC, et al. Neurohormonal effects of furosemide withdrawal in elderly heart failure patients with normal systolic function. Eur J Heart Fail 2003; 5: 47–53PubMedCrossRefGoogle Scholar
  44. 44.
    Cosin J, Diez J. Torasemide in chronic heart failure: results of the TORIC study. Eur J Heart Fail 2002; 4: 507–13PubMedCrossRefGoogle Scholar
  45. 45.
    Lopez B, Querejeta R, Gonzalez A, et al. Effects of loop diuretics on myocardial fibrosis and collagen type I turnover in chronic heart failure. J Am Coll Cardiol 2004; 43: 2028–35PubMedCrossRefGoogle Scholar
  46. 46.
    Willenheimer R, van Veldhuisen DJ, Silke B, et al. Effect on survival and hospitalization of initiating treatment for chronic heart failure with bisoprolol followed by enalapril, as compared with the opposite sequence: results of the randomized Cardiac Insufficiency Bisoprolol Study (CIBIS) III. Circulation 2005; 112: 2426–35PubMedCrossRefGoogle Scholar
  47. 47.
    Garg R, Yusuf S. Overview of randomized trials of angiotensinconverting enzyme inhibitors on mortality and morbidity in patients with heart failure: Collaborative Group on ACE Inhibitor Trials. JAMA 1995; 273: 1450–6PubMedCrossRefGoogle Scholar
  48. 48.
    Fiather MD, Yusuf S, Kober L, et al. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-inhibitor Myocardial Infarction Collaborative Group. Lancet 2000; 355: 1575–81CrossRefGoogle Scholar
  49. 49.
    Sin DD, McAlister FA. The effects of beta-blockers on morbidity and mortality in a population-based cohort of 11,942 elderly patients with heart failure. Am J Med 2002; 113: 650–6PubMedCrossRefGoogle Scholar
  50. 50.
    Havranek EP, Abrams F, Stevens E, et al. Determinants of mortality in elderly patients with heart failure: the role of angiotensin-converting enzyme inhibitors. Arch Intern Med 1998; 158: 2024–8PubMedCrossRefGoogle Scholar
  51. 51.
    Pulignano G, Del Sindaco D, Tavazzi L, et al. Clinical features and outcomes of elderly outpatients with heart failure followed up in hospital cardiology units: data from a large nationwide cardiology database (IN-CHF Registry). Am Heart J 2002; 143: 45–55PubMedCrossRefGoogle Scholar
  52. 52.
    Greenbaum R, Zucchelli P, Caspi A, et al. Comparison of the pharmacokinetics of fosinoprilat with enalaprilat and lisinopril in patients with congestive heart failure and chronic renal insufficiency. Br J Clin Pharmacol 2000; 49: 23–31PubMedCrossRefGoogle Scholar
  53. 53.
    Hoyer J, Schulte KL, Lenz T. Clinical pharmacokinetics of angiotensin converting enzyme (ACE) inhibitors in renal failure. Clin Pharmacokinet 1993; 24: 230–54PubMedCrossRefGoogle Scholar
  54. 54.
    Granger CB, McMurray JJ, Yusuf S, et al. Effects of can-desartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet 2003; 362: 772–6PubMedCrossRefGoogle Scholar
  55. 55.
    Maggioni AP, Anand I, Gottlieb SO, et al. Effects of valsartan on morbidity and mortality in patients with heart failure not receiving angiotensin-converting enzyme inhibitors. J Am Coll Cardiol 2002; 40: 1414–21PubMedCrossRefGoogle Scholar
  56. 56.
    Pitt B, Poole-Wilson PA, Segal R, et al. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial. The Losartan Heart Failure Survival Study ELITE II. Lancet 2000; 355: 1582–7PubMedCrossRefGoogle Scholar
  57. 57.
    Pfeffer MA, McMurray JJ, Velazquez EJ, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003; 349: 1893–906PubMedCrossRefGoogle Scholar
  58. 58.
    Cohn JN, Tognoni G. A randomized trial of the angiotensinreceptor blocker valsartan in chronic heart failure. N Engl J Med 2001; 345: 1667–75PubMedCrossRefGoogle Scholar
  59. 59.
    McMurray JJ, Ostergren J, Swedberg K, et al. Effects of can-desartan in patients with chronic heart failure and reduced leftventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 2003; 362: 767–71PubMedCrossRefGoogle Scholar
  60. 60.
    Packer M, Coats AJ, Fowler MB, et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001; 344: 1651–8PubMedCrossRefGoogle Scholar
  61. 61.
    Goldstein S, Fagerberg B, Hjalmarson A, et al. Metoprolol controlled release/extended release in patients with severe heart failure: analysis of the experience in the MERIT-HF study. J Am Coll Cardiol 2001; 38: 932–8PubMedCrossRefGoogle Scholar
  62. 62.
    Erdmann E, Lechat P, Verkenne P, et al. Results from post-hoc analyses of the CIBIS II trial: effect of bisoprolol in high-risk patient groups with chronic heart failure. Eur J Heart Fail 2001; 3: 469–79PubMedCrossRefGoogle Scholar
  63. 63.
    Deedwania PC, Gottlieb S, Ghali JK, et al. Efficacy, safety and tolerability of beta-adrenergic blockade with metoprolol CR/XL in elderly patients with heart failure. Eur Heart J 2004; 25: 1300–9PubMedCrossRefGoogle Scholar
  64. 64.
    Wikstrand J, Wedel H, Ghali J, et al. How should subgroup analyses affect clinical practice? Insights from the Metoprolol Succinate Controlled-Release/Extended-Release Randomized Intervention Trial in Heart Failure (MERIT-HF). Card Electrophysiol Rev 2003; 7: 264–75PubMedCrossRefGoogle Scholar
  65. 65.
    Fiather MD, Shibata MC, Coats AJ, et al. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 2005; 26: 215–25CrossRefGoogle Scholar
  66. 66.
    Packer M, Bristow MR, Cohn JN, et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure: U.S. Carvedilol Heart Failure Study Group. N Engl J Med 1996; 334: 1349–55PubMedCrossRefGoogle Scholar
  67. 67.
    McMurray J. Making sense of SENIORS. Eur Heart J 2005; 26: 203–6PubMedCrossRefGoogle Scholar
  68. 68.
    The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 1999; 353: 9–13Google Scholar
  69. 69.
    Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353: 2001–7Google Scholar
  70. 70.
    Poole-Wilson PA, Swedberg K, Cleland JG, et al. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet 2003; 362: 7–13PubMedCrossRefGoogle Scholar
  71. 71.
    Coca SG, Buller GK. COMET: a proposed mechanism of action to explain the results and concerns about dose [letter]. Lancet 2003; 362: 1076PubMedCrossRefGoogle Scholar
  72. 72.
    Wikstrand J, Fagerberg B, Goldstein S, et al. COMET: a proposed mechanism of action to explain the results and concerns about dose [letter]. Lancet 2003; 362: 1076PubMedCrossRefGoogle Scholar
  73. 73.
    Hjalmarson A, Waagstein F. COMET: a proposed mechanism of action to explain the results and concerns about dose [letter]. Lancet 2003; 362: 1077PubMedCrossRefGoogle Scholar
  74. 74.
    Poole-Wilson PA, Swedberg K, Cleland JG, et al. COMET: a proposed mechanism of action to explain the results and concerns about dose [letter]. Lancet 2003; 362: 1077CrossRefGoogle Scholar
  75. 75.
    Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure: Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999; 341: 709–17PubMedCrossRefGoogle Scholar
  76. 76.
    Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003; 348: 1309–21PubMedCrossRefGoogle Scholar
  77. 77.
    DIG. The effect of digoxin on mortality and morbidity in patients with heart failure: the Digitalis Investigation Group. N Engl J Med 1997; 336: 525–33CrossRefGoogle Scholar
  78. 78.
    Ahmed A, Rich MW, Love TE, et al. Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J 2006; 27: 178–86PubMedCrossRefGoogle Scholar
  79. 79.
    Taylor AL, Ziesche S, Yancy C, et al. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med 2004; 351: 2049–57PubMedCrossRefGoogle Scholar
  80. 80.
    Elkayam U, Johnson JV, Shotan A, et al. Double-blind, placebo-controlled study to evaluate the effect of organic nitrates in patients with chronic heart failure treated with angiotensin-converting enzyme inhibition. Circulation 1999; 99: 2652–7PubMedCrossRefGoogle Scholar
  81. 81.
    Katz S. Safety of calcium antagonists in patients with congestive heart failure. Clin Ther 1997; 19Suppl. A: 92–113PubMedCrossRefGoogle Scholar
  82. 82.
    Packer M, O’Connor CM, Ghali JK, et al. Effect of amlodipine on morbidity and mortality in severe chronic heart failure: Prospective Randomized Amlodipine Survival Evaluation Study Group. N Engl J Med 1996; 335: 1107–14PubMedCrossRefGoogle Scholar
  83. 83.
    Cohn JN, Ziesche S, Smith R, et al. Effect of the calcium antagonist felodipine as supplementary vasodilator therapy in patients with chronic heart failure treated with enalapril: VHeFT III. Vasodilator-Heart Failure Trial (V-HeFT) Study Group. Circulation 1997; 96: 856–63PubMedCrossRefGoogle Scholar
  84. 84.
    Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005; 352: 1539–49PubMedCrossRefGoogle Scholar
  85. 85.
    Cleland JG, Daubert JC, Erdmann E, et al. Longer-term effects of cardiac resynchronization therapy on mortality in heart failure (the CArdiac REsynchronization-Heart Failure [CARE-HF] trial extension phase). Eur Heart J 2006; 27: 1928–32PubMedCrossRefGoogle Scholar
  86. 86.
    Calvert MJ, Freemantle N, Yao G, et al. Cost-effectiveness of cardiac resynchronization therapy: results from the CARE-HF trial. Eur Heart J 2005; 26: 2681–8PubMedCrossRefGoogle Scholar
  87. 87.
    Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005; 352: 225–37PubMedCrossRefGoogle Scholar
  88. 88.
    Nanthakumar K, Epstein AE, Kay GN, et al. Prophylactic implantable cardioverter-defibrillator therapy in patients with left ventricular systolic dysfunction: a pooled analysis of 10 primary prevention trials. J Am Coll Cardiol 2004; 44: 2166–72PubMedCrossRefGoogle Scholar
  89. 89.
    Healey JS, Hallstrom AP, Kuck KH, et al. Role of the implantable defibrillator among elderly patients with a history of life-threatening ventricular arrhythmias. Eur Heart J 2007; 28: 1746–9PubMedCrossRefGoogle Scholar
  90. 90.
    Grimm W, Stula A, Sharkova J, et al. Outcomes of elderly recipients of implantable cardioverter defibrillators. Pacing Clin Electrophysiol 2007; 30Suppl. 1: S134–8PubMedGoogle Scholar
  91. 91.
    Kitzman DW. Diastolic heart failure in the elderly. Heart Fail Rev 2002; 7: 17–27PubMedCrossRefGoogle Scholar
  92. 92.
    Banerjee P, Clark AL, Cleland JG. Diastolic heart failure: a difficult problem in the elderly. Am J Geriatr Cardiol 2004; 13: 16–21PubMedCrossRefGoogle Scholar
  93. 93.
    Regitz-Zagrosek V, Brokat S, Tschope C. Role of gender in heart failure with normal left ventricular ejection fraction. Prog Cardiovasc Dis 2007; 49: 241–51PubMedCrossRefGoogle Scholar
  94. 94.
    Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 2003; 362: 777–81PubMedCrossRefGoogle Scholar
  95. 95.
    Cleland JG, Tendera M, Adamus J, et al. The Perindopril in Elderly People with Chronic Heart Failure (PEP-CHF) study. Eur Heart J 2006; 27: 2338–45PubMedCrossRefGoogle Scholar
  96. 96.
    Bergstrom A, Andersson B, Edner M, et al. Effect of carvedilol on diastolic function in patients with diastolic heart failure and preserved systolic function: results of the Swedish Doppler-echocardiographic study (SWEDIC). Eur J Heart Fail 2004; 6: 453–61PubMedCrossRefGoogle Scholar
  97. 97.
    Aronow WS, Ahn C, Kronzon I. Effect of propranolol versus no propranolol on total mortality plus nonfatal myocardial infarction in older patients with prior myocardial infarction, congestive heart failure, and left ventricular ejection fraction ≥40% treated with diuretics plus angiotensin-converting enzyme inhibitors. Am J Cardiol 1997; 80: 207–9PubMedCrossRefGoogle Scholar
  98. 98.
    Arques S, Ambrosi P, Gelisse R, et al. Prevalence of angiographic coronary artery disease in patients hospitalized for acute diastolic heart failure without clinical and electrocardiographic evidence of myocardial ischemia on admission. Am J Cardiol 2004; 94: 133–5PubMedCrossRefGoogle Scholar
  99. 99.
    Casarett D, Van Ness PH, O’Leary JR, et al. Are patient pbl]References for life-sustaining treatment really a barrier to hospice enrollment for older adults with serious illness? J Am Geriatr Soc 2006; 54: 472–8PubMedCrossRefGoogle Scholar
  100. 100.
    Pullicino PM, Hart J. Cognitive impairment in congestive heart failure? Embolism vs hypoperfusion. Neurology 2001; 57: 1945–6PubMedCrossRefGoogle Scholar
  101. 101.
    Zuccala G, Onder G, Marzetti E, et al. Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure. Eur Heart J 2005; 26: 226–33PubMedCrossRefGoogle Scholar
  102. 102.
    Brunner-La Rocca HP, Capraro J, Kiowsk W. Compliance by referring physicians with recommendations on heart failure therapy from a tertiary center. J Cardiovasc Pharmacol Ther 2006; 11: 85–92PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Gregor Leibundgut
    • 1
  • Matthias Pfisterer
    • 1
  • Hans-Peter Brunner-La Rocca
    • 1
  1. 1.CardiologyUniversity Hospital BaselBaselSwitzerland

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