Skip to main content

Heart Failure of Aging: Clinical Considerations

  • Chapter
  • First Online:
Book cover Heart Failure

Part of the book series: Contemporary Cardiology ((CONCARD))

  • 1399 Accesses

Abstract

Although the physiological decline occurring during aging is much more subtle than that observed in young people and adults with cardiac disease, heart failure (HF) is a disease of the elderly. This may be related to a significant loss of cardiac myocytes occurring through apoptosis; this loss may be secondary to mitochondrial dysfunction, probably caused by chronic exposure to ROS, which will result in damaged mtDNA (mutations and deletions) and mitochondrial membranes. In this chapter, we will discuss clinical aspects of HF in the elderly and define their etiology, pathophysiology, clinical presentation, diagnosis and common approaches to therapeutic interventions, including pharmacotherapy, and device and replacement therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. O’Connell J (2000) The economic burden of heart failure. Clin Cardiol 23:III6–III10

    Article  PubMed  Google Scholar 

  2. Kannel WB, Belanger AJ (1991) Epidemiology of heart failure. Am Heart J 121:951–957

    Article  PubMed  CAS  Google Scholar 

  3. Anversa P, Rota M, Urbanek K, Hosoda T, Sonnenblick EH, Leri A, Kajstura J, Bolli R (2005) Myocardial aging – a stem cell problem. Basic Res Cardiol 100:482–493

    Article  PubMed  CAS  Google Scholar 

  4. Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D (1999) Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol 33:1948–1955

    Article  PubMed  CAS  Google Scholar 

  5. Kitzman DW (2000) Heart failure with normal systolic function. Clin Geriatr Med 16:489–512

    Article  PubMed  CAS  Google Scholar 

  6. Wei JY (1992) Age and the cardiovascular system. N Engl J Med 327:1735–1739

    Article  PubMed  CAS  Google Scholar 

  7. Olivetti G, Melissari M, Capasso JM, Anversa P (1991) Cardiomyopathy of the aging human heart. Myocyte loss and reactive cellular hypertrophy. Circ Res 68:1560–1568

    Article  PubMed  CAS  Google Scholar 

  8. Lakatta EG (2000) Cardiovascular aging in health. Clin Geriatr Med 16:419–444

    Article  PubMed  CAS  Google Scholar 

  9. Van Coster R, Smet J, George E, De Meirleir L et al (2001) Blue native polyacrylamide gel electrophoresis: a powerful tool in diagnosis of oxidative phosphorylation defects. Pediatr Res 50:658–665

    Article  PubMed  Google Scholar 

  10. Brunt UT, Terman A (2002) The mitochondrial-lysosomal axis theory of aging: accumulation of damaged mitochondria as a result of imperfect autophagocytosis. Eur J Biochem 269:1996–2002

    Article  Google Scholar 

  11. Gottdiener JS, Arnold AM, Aurigemma GP, Polak JF et al (2000) Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol 35:1628–1637

    Article  PubMed  CAS  Google Scholar 

  12. Ghali JK, Kadakia S, Cooper R, Ferlinz J (1988) Precipitating factors leading to decompensation of heart failure. Traits among urban blacks. Arch Intern Med 148:2013–2016

    Article  PubMed  CAS  Google Scholar 

  13. Tresch DD (2000) Clinical manifestations, diagnostic assessment, and etiology of heart failure in elderly patients. Clin Geriatr Med 16:445–456

    Article  PubMed  CAS  Google Scholar 

  14. Heiat A, Gross CP, Krumholz HM (2002) Representation of the elderly, women, and minorities in heart failure clinical trials. Arch Intern Med 162:1682–1688

    Article  PubMed  Google Scholar 

  15. Incalzi AR, Capparella O, Gemma A, Porcedda P, Raccis G, Sommella L, Carbonin PU (1992) A simple method of recognizing geriatric patients at risk for death and disability. J Am Geriatr Soc 40:34–38

    PubMed  CAS  Google Scholar 

  16. Arnold JM, Liu P, Demers C, Dorian P et al (2006) Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: diagnosis and management. Can J Cardiol 22:23–45

    Article  PubMed  Google Scholar 

  17. Zuccala G, Pedone C, Cesari M, Onder G, Pahor M, Marzetti E, Lo Monaco MR, Cocchi A, Carbonin P, Bernabei R (2003) The effects of cognitive impairment on mortality among hospitalized patients with heart failure. Am J Med 115:97–103

    Article  PubMed  Google Scholar 

  18. Kelly KG, Zisselman M, Cutillo-Schmitter T, Reichard R, Payne D, Denman SJ (2001) Severity and course of delirium in medically hospitalized nursing facility residents. Am J Geriatr Psychiatry 9:72–77

    PubMed  CAS  Google Scholar 

  19. Gottlieb SS, Khatta M, Friedmann E, Einbinder L et al (2004) The influence of age, gender, and race on the prevalence of depression in heart failure patients. J Am Coll Cardiol 43:1542–1549

    Article  PubMed  Google Scholar 

  20. Joynt KE, Whellan DJ, O’Connor CM (2004) Why is depression bad for the failing heart? A review of the mechanistic relationship between depression and heart failure. J Card Fail 10:258–271

    Article  PubMed  Google Scholar 

  21. Vogels RL, Scheltens P, Schroeder-Tanka JM, Weinstein HC (2007) Cognitive impairment in heart failure: a systematic review of the literature. Eur J Heart Fail 9:440–449

    Article  PubMed  Google Scholar 

  22. Vogels RL, Oosterman JM, van Harten B, Gouw AA, Schroeder-Tanka JM, Scheltens P, van der Flier WM, Weinstein HC (2007) Neuroimaging and correlates of cognitive function among patients with heart failure. Dement Geriatr Cogn Disord 24:418–423

    Article  PubMed  Google Scholar 

  23. Vogels RL, Oosterman JM, van Harten B, Scheltens P, van der Flier WM, Schroeder-Tanka JM, Weinstein HC (2007) Profile of cognitive impairment in chronic heart failure. J Am Geriatr Soc 55:1764–1770

    Article  PubMed  Google Scholar 

  24. Cournot M, Leprince P, Destrac S, Ferrieres J (2007) Usefulness of in-hospital change in B-type natriuretic peptide levels in predicting long-term outcome in elderly patients admitted for decompensated heart failure. Am J Geriatr Cardiol 16:8–14

    Article  PubMed  Google Scholar 

  25. Cournot M, Mourre F, Castel F, Ferrières J, Destrac S (2008) Optimization of the use of B-type natriuretic peptide levels for risk stratification at discharge in elderly patients with decompensated heart failure. Am Heart J 155:986–989

    Article  PubMed  CAS  Google Scholar 

  26. Haugen E, Gan LM, Isic A, Skommevik T, Fu M (2008) Increased interleukin-6 but not tumour necrosis factor-alpha predicts mortality in the population of elderly heart failure patients. Exp Clin Cardiol 13:19–24

    PubMed  CAS  Google Scholar 

  27. Das A, Abraham S, Deswal A (2008) Advances in the treatment of heart failure with a preserved ejection fraction. Curr Opin Cardiol 23:233–240

    Article  PubMed  Google Scholar 

  28. Shah R, Wang Y, Foody JM (2008) Effect of statins, angiotensin-converting enzyme inhibitors, and beta blockers on survival in patients > or =65 years of age with heart failure and preserved left ventricular systolic function. Am J Cardiol 101:217–222

    Article  PubMed  CAS  Google Scholar 

  29. Cleland JG, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J (2006) The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 27:2338–2345

    Article  PubMed  CAS  Google Scholar 

  30. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J (2003) Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 362:777–781

    Article  PubMed  CAS  Google Scholar 

  31. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, Anderson S, Donovan M, Iverson E, Staiger C, Ptaszynska A (2008) Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med 359:2456–2467

    Article  PubMed  CAS  Google Scholar 

  32. van Veldhuisen DJ, Cohen-Solal A, Bohm M, Anker SD, Babalis D, Roughton M, Coats AJ, Poole-Wilson PA, Flather MD (2009) Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction: data from SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure). J Am Coll Cardiol 53:2150–2158

    Article  PubMed  Google Scholar 

  33. Ahmed A, Kiefe CI, Allman RM, Sims RV, DeLong JF (2002) Survival benefits of angiotensin-converting enzyme inhibitors in older heart failure patients with perceived contraindications. J Am Geriatr Soc 50:1659–1666

    Article  PubMed  Google Scholar 

  34. Flather MD, Shibata MC, Coats AJ, Van Veldhuisen DJ et al (2005) Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 26:215–225

    Article  PubMed  CAS  Google Scholar 

  35. Hori M, Kitabatake A, Tsutsui H, Okamoto H, Shirato K, Nagai R, Izumi T, Yokoyama H, Yasumura Y, Ishida Y, Matsuzaki M, Oki T, Sekiya M (2005) Rationale and design of a randomized trial to assess the effects of beta-blocker in diastolic heart failure; Japanese Diastolic Heart Failure Study (J-DHF). J Card Fail 11:542–547

    Article  PubMed  Google Scholar 

  36. Hagen TM, Moreau R, Suh JH, Visioli F (2002) Mitochondrial decay in the aging rat heart: evidence for improvement by dietary supplementation with acetyl-L-carnitine and/or lipoic acid. Ann NY Acad Sci 959:491–507

    Article  PubMed  CAS  Google Scholar 

  37. Tiano L, Fedeli D, Santoni G, Davies I, Wakabayashi T, Falcioni G (2003) Ebselen prevents mitochondrial ageing due to oxidative stress: in vitro study of fish erythrocytes. Mitochondrion 2:428–436

    Article  PubMed  CAS  Google Scholar 

  38. Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, Cadoret C, Fish LS, Garber L, Kelleher M, Bates DW (2003) Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 289:1107–1116

    Article  PubMed  Google Scholar 

  39. Miura T, Kojima R, Sugiura Y, Mizutani M, Takatsu F, Suzuki Y (2000) Effect of aging on the incidence of digoxin toxicity. Ann Pharmacother 34:427–432

    Article  PubMed  CAS  Google Scholar 

  40. Cleland JG, Cohen-Solal A, Aguilar JC, Dietz R et al (2002) Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey. Lancet 360:1631–1639

    Article  PubMed  CAS  Google Scholar 

  41. Gonseth J, Guallar-Castillon P, Banegas JR, Rodriguez-Artalejo F (2004) The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J 25:1570–1595

    Article  PubMed  Google Scholar 

  42. Alehagen U, Rahmqvist M, Paulsson T (2008) Levin LA.Quality-adjusted life year weights among elderly patients with heart failure. Eur J Heart Fail 10:1033–1039

    Article  PubMed  Google Scholar 

  43. Bleeker GB, Schalij MJ, Molhoek SG, Boersma E, Steendijk P, van der Wall EE, Bax JJ (2005) Comparison of effectiveness of cardiac resynchronization therapy in patients <70 versus > or =70 years of age. Am J Cardiol 96:420–422

    Article  PubMed  Google Scholar 

  44. Delnoy PP, Ottervanger JP, Luttikhuis HO, Elvan A, Misier AR, Beukema WP, van Hemel NM (2008) Clinical response of cardiac resynchronization therapy in the elderly. Am Heart J 155:746–751

    Article  PubMed  Google Scholar 

  45. Piccini JP, Hernandez AF, Dai D, Thomas KL, Lewis WR, Yancy CW, Peterson ED, Fonarow GC; Get With the Guidelines Steering Committee and Hospitals (2008) Use of cardiac resynchronization therapy in patients hospitalized with heart failure. Circulation 118:926–933

    Article  PubMed  Google Scholar 

  46. McAlister FA (2008) Cardiac resynchronization therapy for heart failure: a hammer in search of nails. Circulation 118:901–903

    Article  PubMed  Google Scholar 

  47. Morgan JA, John R, Weinberg AD, Remoli R et al (2003) Long-term results of cardiac transplantation in patients 65 years of age and older: a comparative analysis. Ann Thorac Surg 76:1982–1987

    Article  PubMed  Google Scholar 

  48. Zuckermann A, Dunkler D, Deviatko E, Bodhjalian A, Czerny M, Ankersmit J, Wolner E, Grimm M (2003) Long-term survival (>10 years) of patients >60 years with induction therapy after cardiac transplantation. Eur J Cardiothorac Surg 24:283–291

    Article  PubMed  Google Scholar 

  49. Potapov EV, Loebe M, Hubler M, Musci M, Hummel M, Weng Y, Hetzer R (1999) Medium-term results of heart transplantation using donors over 63 years of age. Transplantation 68:1834–1838

    Article  PubMed  CAS  Google Scholar 

  50. Blanche C, Kamlot A, Blanche DA, Kearney B, Magliato KE, Czer LS, Trento A (2002) Heart transplantation with donors fifty years of age and older. J Thorac Cardiovasc Surg 123:810–815

    Article  PubMed  Google Scholar 

  51. Morgan JA, John R, Weinberg AD, Remoli R, Kherani AR, Vigilance DW, Schanzer BM, Bisleri G, Mancini DM, Oz MC, Edwards NM (2003) Long-term results of cardiac transplantation in patients 65 years of age and older: a comparative analysis. Ann Thorac Surg 76:1982–1987

    Article  PubMed  Google Scholar 

  52. Marelli D, Kobashigawa J, Hamilton MA, Moriguchi JD, Kermani R, Ardehali A, Patel J, Noguchi E, Beygui R, Laks H, Plunkett M, Shemin R, Esmailian F (2008) Long-term outcomes of heart transplantation in older recipients. J Heart Lung Transplant 27:830–834

    Article  PubMed  Google Scholar 

  53. Weiss ES, Nwakanma LU, Patel ND, Yuh DD (2008) Outcomes in patients older than 60 years of age undergoing orthotopic heart transplantation: an analysis of the UNOS database. J Heart Lung Transplant 27:184–191

    Article  PubMed  Google Scholar 

  54. Flather MD, Yusuf S, Kober L, Pfeffer M, Hall A et al (2000) 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 355:1575–1581

    Article  PubMed  CAS  Google Scholar 

  55. Richardson LG, Rocks M (2001) Women and heart failure. Heart Lung 30:87–97

    Article  PubMed  CAS  Google Scholar 

  56. McLean AJ, Le Couteur DG (2004) Aging biology and geriatric clinical pharmacology. Pharmacol Rev 56:163–184

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to José Marín-García MD .

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Marín-García, J. (2010). Heart Failure of Aging: Clinical Considerations. In: Heart Failure. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-147-9_17

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-147-9_17

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-146-2

  • Online ISBN: 978-1-60761-147-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics