Therapeutic alternatives for treating heart failure in elderly patients

Heart failure (HF) is a leading cause of mortality and hospitalization among the elderly worldwide. Comorbidities, which are common among HF patients and especially among the elderly, worsen prognosis and make its management more difficult and complicated. In addition, age, in itself, is a predictive variable of bad prognosis in HF. Nearly half the patients with HF are found to have a normal left ventricular ejection fraction. Clinical and therapeutic trials in HF with preserved ejection fraction are scant and their results have been disappointing. Furthermore, most of them did not include cohorts of elderly people large enough to draw clear conclusions to guide therapy. The aim of the present article is to review the most important trials that have focused on heart failure in people over 65 years over the last 10 years, and to analyze the results and to draw some conclusions that would enable physicians to guide their day-to-day practice. Hence, a review is made of beta-blockers, angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers, aldosterone antagonists, nitrates with hydralazine, digoxin, statins, implantable cardioverter-defibrillator and cardiac resynchronization.