Friday, April 11, 2008

Elderly Patients with Heart Failure Require Special Treatment

Older adults with heart failure require frequent hospitalization, accounting for significant burden on the patient, families, and our healthcare system. As more people reach age 65, elder care will escalate. Most people in the senior population have multiple health issues, which require clinical trials to meet increasing demands for healthcare delivery. However, few clinical trials target elderly patients with heart failure. Co-morbidities such as kidney failure and urinary incontinence, which may inhibit therapy with diuretics, cognitive impairment, arthritis, lung disease, and heart rhythm disturbances, require special approaches for heart failure in the presence of advanced age.

Many factors have an indirect impact on treating elders with heart failure, though medication standards are the same whether a patient is young or old. Targeted treatment should address specific issues that are unique to our increasingly older population.

As we age, kidney function declines, as does the ability to eliminate sodium and water. The result leads to disturbances in electrolyte (sodium, potassium, chloride) balance. Urinary tract abnormalities, resulting in incontinence (inability to hold urine in the bladder) may not be reported to physicians due to embarrassment. Many patients avoid taking their medications as a result.

Heart failure causes shortness of breath and decreased exercise tolerance, yet elderly patients with chronic lung disease should not be withheld from receiving beta-blockers, medications that are shown to improve symptoms of heart failure.

Low blood pressure can result from standard heart failure treatment, causing falls and additional hospitalizations. Evaluation is needed to replace medications that may contribute to worsening problems, making it necessary to choose different medications for treatment.

Arthritis requires the use of pain medications, such as anti-inflammatories, that are known to impair kidney function and promote bleeding, providing yet another challenge to physicians.

Recommendations also include screening for coronary artery disease via cardiac catheterization, much the same as in younger patients. Evidence shows that treatment with cholesterol lowering drugs and medications to treat angina improve prognosis. Surgery can also be considered to repair heart valve disease and bypass coronary artery disease, depending on other health risks.

Short-term treatment for depression is also shown to improve survival of elderly patients with heart failure, but it is recommended that they be used with caution.
It is estimated that elderly patients with heart failure have a survival rate of less than three years, making the prognosis worse than those who have cancer. Many patients are at a disadvantage because they have less understanding of their disease process.

If you or a family member has a diagnosis of heart failure, make it a priority to become educated about treatment options. Report medication problems and new symptoms to your doctor. Recognize that multiple approaches may be necessary to improve survival and quality of life. A look at the special needs required to treat elders with heart failure makes it apparent that the problem is challenging for patients as well as physicians.

There are many other treatment options, such as pacemakers, implantable cardiac defibrillators, and daily exercises, and this article highlights a few of the special treatments needed to treat heart failure in elders.

The best approach for the management of heart failure includes risk factor reduction, patient and family education, and the proper use of medication. The benefits include fewer hospitalizations, improved quality of life and increased survival.

From International Journal of Clinical Practice