Diagnosis and Management of Heart Failure in Older Adults

Considerations Regarding Management of Heart Failure in Older Adults

Understanding noncardiovascular comorbidities and geriatric syndromes in elderly patients with heart failure (HF) is important as the average age of the population increases. Healthcare professionals need to consider these complex dynamics when managing older adults with HF, especially those older than 80. A number of small studies have described associations between HF and major geriatric domains. With information on patients' cognitive, functional decline, and ability to adhere to therapy, physicians can plan for individualized treatment goals and recommendations for these patients.

Literature Review: Pathophysiology of Heart Failure with Preserved Ejection Fraction

Heart failure with preserved ejection fraction is a growing public health concern, a disease with poor health outcomes, and is showing increased prevalence globally. This review paper explores the literature with a focus on the pathophysiology and microbiology of preserved ejection fraction heart failure while drawing connections between preserved and reduced ejection fraction states. The discussion teases out the cellular level changes that affect the overall dysfunction of the cardiac tissue, including the clinical manifestations, microbiological changes (endothelial cells, fibroblasts, cardiomyocytes, and excitation-contraction coupling), and the burden of structural diastolic dysfunction. The goal of this review is to summarize the pathophysiological disease state of heart failure with preserved ejection fraction to enhance understanding, knowledge, current treatment models of this pathology.

Mineralocorticoid Receptor Antagonist Use in Heart Failure With Reduced Ejection Fraction and End-Stage Renal Disease Patients on Dialysis: A Literature Review

Mineralocorticoid receptor antagonists (MRAs) are known to have a proven mortality benefit in heart failure with reduced ejection fraction (HFrEF) without kidney disease. As patients with end-stage renal disease (ESRD) requiring either peritoneal dialysis or hemodialysis were excluded in clinical trials of HFrEF, the data are scant on the appropriate use of MRAs in this population. The unknown efficacy, along with concerns of adverse effects such as hyperkalemia, has limited the willingness of clinicians to consider using MRAs in these patients. However, it is unclear whether the risk of hyperkalemia is present if a patient is oliguric or anuric. Current guidelines recommend against the use of MRAs in patients with chronic kidney disease, but do not address the use of MRAs in patients requiring dialysis. This article will review the epidemiology of heart failure in ESRD, the pathophysiological derangements of the renin-angiotensin-aldosterone system in patients with kidney disease, and the results from case series and trials of the use of MRAs in ESRD with HFrEF. Although limited to several small trials using MRAs in peritoneal and hemodialysis patients with or without HFrEF, the current literature appears to show the potential for clinical benefits with little risk.

The efficacy of a nursing care and follow-up program for patients with heart failure: Study protocol for a randomized controlled trial

BACKGROUND

Heart failure (HF) is one of the primary causes of the increasing public health costs, incidence rate and mortality of heart disease. As treatment options for the HF have evolved, people have a better understanding of overall burden of HF, resulting a more centralized method for the treatment of these patients with chronic diseases. At present, with the rapid progress of medical technology, the nursing mode must be updated accordingly. The objective of this trial is to investigate the effects of the program of nursing care and follow-up on life quality, self-care, and the rehospitalization of patients with HF.

METHOD

This is a randomized controlled study to be carried out from November 2020 to March 2021 and was granted through the Ethics Committee of Changshan County People's Hospital (CCPH002376). The patients meet the following criteria will be included: the age of the patients is 18 years and above, and the functional classification is NYHA II or NYHA III. The patients with the following criteria will be excluded: patients who have received the by-pass surgery in the last 6 months; cancer patients are given radiotherapy or chemotherapy; patients with severe renal failure requiring dialysis; patients with chronic obstructive pulmonary disease who need ventilation; and patients with hearing or visual impairment. In our experiment, patient information scale, the life quality scale (The Left Ventricular Dysfunction Scale) and Self-Care of HF Index are utilized for the assessment. All the analyses are implemented with SPSS for Windows Version 20.0.

RESULTS

Impact of experimental programs on outcomes will be illustrated in the Table.

CONCLUSION

We hypothesize that the nursing care conducted for the HF patients may improve the life quality and self-care.

TRIAL REGISTRATION NUMBER

researchregistry 6129.

Mildly symptomatic heart failure with reduced ejection fraction: diagnostic and therapeutic considerations

AIMS

Whereas up to about half of patients with heart failure with reduced ejection fraction (HFrEF) report no or only mild symptoms and are considered as clinically stable, the progressive nature of HFrEF, often silent, renders clinical stability a misleading situation, especially if disease progression is unrecognized. We highlight the challenges in the definition of clinical stability and mild symptomatic status in HFrEF, outline clinical characteristics and available diagnostic tools, and discuss evidence and gaps in the current guidelines for the management of these patients.

METHODS AND RESULTS

This is a state-of-the-art review that focuses on clinical, diagnostic, and therapeutic aspects in mildly symptomatic HFrEF patients; summarizes the challenges; and proposes directions for future research in this group of patients. The New York Heart Association classification has been widely used as a measure of prognosis in HFrEF, but it lacks objectivity and reproducibility in terms of symptoms assessment. The definition of clinical stability as described in current guidelines is vague and may often lead to underdiagnosis of disease progression in patients who appear to be 'stable' but in fact are at an increased risk of clinical worsening, hospitalization, or death. Although an increasing number of clinical trials proved that the efficacy of HFrEF therapies was unrelated to the symptomatic status of patients and led to their implementation early in the course of the disease, clinical inertia in terms of under-prescription or underdosing of guideline-recommended medications in mildly symptomatic HFrEF patients is still a challenging issue to deal with.

CONCLUSIONS

Mildly symptomatic status in a patient with HFrEF is very frequent; it should not be ignored and should not be regarded as an index of disease stability. The application of risk scores designed to predict mortality and mode of death should be engaged among mildly symptomatic patients, not only to identify the most suitable HF candidates for cardioverter defibrillator implantation, but also to identify patients who might benefit from early intensification of medical treatment before the implementation of more interventional approaches.

Gender differences in the impact of health literacy on hospital readmission among older heart failure patients: A prospective cohort study

AIMS

To investigate the impact of limited health literacy on 1-year hospital readmission among both older men and women with heart failure.

DESIGN

Prospective cohort study.

METHODS

A total of 286 patients with heart failure (men = 144, women = 142) aged 65 years or older at baseline from two tertiary hospitals were enrolled from June-November 2017. Patients were followed up until November 2018. The Brief Health Literacy Screening Tool was used to assess baseline health literacy. One-year readmission after discharge was assessed via medical records or telephone interview. A hierarchical logistic regression was performed.

RESULTS

The prevalence rates of limited health literacy and 1-year hospital readmission among older women were 74.7% and 35.9%, respectively, compared with 48.6% and 27.1% in older men. Limited health literacy significantly increased the risk of 1-year hospital readmission in both older men and women with heart failure. More importantly, older women with limited health literacy had a much higher risk of hospital readmission (odds ratio: 10.17, 95% confidence interval: 2.19-47.14) than did older men with limited health literacy (odds ratio: 5.27, 95% confidence interval: 2.04-13.59).

CONCLUSIONS

Our findings highlight that a baseline assessment of health literacy would help prevent unplanned hospital readmissions after discharge in both older men and women with heart failure. Health professionals should recognize that women with limited health literacy are more vulnerable to re-hospitalization than are men with limited health literacy.

IMPACT

Few studies have addressed gender differences in the link between health literacy and hospital readmission among patients with heart failure. We found that older women with limited health literacy had a much higher risk of hospital readmission than did their male counterparts. Health professionals should be aware of gender differences in health literacy in discharge planning, including self-management counselling for older patients with heart failure.

Hormonal Replacement Therapy in Heart Failure: Focus on Growth Hormone and Testosterone

A growing body of evidence led to the hypothesis that heart failure (HF) could be considered a multiple hormone deficiency syndrome. Deficiencies in the main anabolic axes cannot be considered as mere epiphenomena, are very common in HF, and are clearly associated with poor cardiovascular performance and outcomes. Growth hormone deficiency and testosterone deficiency play a pivotal role and the replacement treatment is an innovative therapy that should be considered. This article appraises the current evidence regarding growth hormone and testosterone deficiencies in HF and reviews novel findings about the treatment of these conditions in HF.