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Reperfusion and Vasodilator Therapy in Elderly Patients with STEMI and Heart Failure: Improving Outcomes

  • Bodh I. Jugdutt
  • Anwar Jelani
  • Seraj Abualnaja
  • Nakul Chander Sharma
  • Joseph Szeman Wong
Chapter

Abstract

The elderly population (aged ≥65 years) has been increasing worldwide. Heart failure (HF) is also common and increasing in the elderly. Cardiovascular (CV) changes with aging predispose the elderly to HF. Comorbidities such as coronary artery disease with ST-segment-elevation myocardial infarction (STEMI) and hypertension (HTN) are more prevalent in the elderly and contribute to the development of HF. Morbidity, hospitalizations, and costs associated with HF are higher in the elderly. Despite improved therapies, the bulk of CV deaths occur in the elderly. Survivors of STEMI develop progressive left ventricular (LV) remodeling and HF with low ejection fraction (HF/Low-EF), while those with HTN develop HF with preserved ejection fraction (HF/PEF). Reasons for the increased HF burden in the elderly include the lack of clinical trial data in elderly patients for specific therapy of adverse remodeling, healing, and HF/low-EF post-STEMI and HF/PEF. Recommendations for reperfusion and vasodilator therapies for the management of HF are based on studies done in mostly younger populations. While reperfusion has many benefits, aging may enhance reperfusion damage, impair healing, and enhance adverse remodeling after STEMI. While vasodilators are attractive agents for their LV unloading and anti-remodeling effects, caution is needed because of aging-related changes affecting the responses in the elderly. This chapter focuses on the roles of reperfusion and vasodilator therapies in the management of HF in elderly survivors of STEMI and chronic HTN and discusses some reasons for the increasing HF burden in that population and some possible ways for improving outcomes, especially in the older-elderly aged ≥75 years.

Keywords

Heart Failure Heart Failure Patient Systemic Vascular Resistance Acute Heart Failure Acute Decompensated Heart Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This work was supported in part by grant # IAP99003 from the Canadian Institutes of Health Research, Ottawa, Ontario. I am indebted to Catherine Jugdutt for the assistance.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Bodh I. Jugdutt
    • 1
  • Anwar Jelani
    • 2
  • Seraj Abualnaja
    • 3
  • Nakul Chander Sharma
    • 4
  • Joseph Szeman Wong
    • 5
  1. 1.2C2 W.C. Mackenzie Health Sciences Centre, Division of Cardiology, Department of MedicineMazankowski Alberta Heart Institute, University of Alberta and HospitalsEdmontonCanada
  2. 2.Department of Medicine, Section of CardiologyKing Abdulaziz HospitalAlhasaSaudi Arabia
  3. 3.Division of Cardiology, Department of MedicineUniversity of AlbertaEdmontonCanada
  4. 4.Division of Cardiology, Department of MedicineMazankowski Heart InstituteEdmontonCanada
  5. 5.Division of Cardiology, Department of MedicineUniversity of Alberta HospitalEdmontonCanada

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