Drug treatment of chronic heart failure in the elderly

Congestive heart failure is a growing public health problem worldwide, particularly in the elderly population, in whom it has a substantial impact on quality of life and survival. Despite the fact that heart failure is the most common reason for hospitalisation over the age of 65 years, most clinical trials have excluded the elderly population. This is unfortunate because it may not be generally assumed that elderly patients are similar to younger ones. Nonspecific symptoms and co-morbidities in the elderly may make diagnosis of heart failure difficult. In addition, physiology changes with age, polypharmacy complicates therapy and the aim of therapy may change in the presence of co-morbidities such as cancer or dementia. Furthermore, drug interactions and adverse effects are frequent in heart failure in general, but increase significantly with age. Nevertheless, there is little evidence that treatment of heart failure should be fundamentally different in elderly patients compared with younger patients, although careful monitoring of medical therapy is of particular importance in elderly heart failure patients. Therefore, general guidelines on diagnosis and therapy of heart failure also apply to elderly patients, but therapy may need to be adjusted to cater for individual needs, potential interactions and altered elimination of drugs. This article summarises the evidence available for treatment in elderly patients with heart failure, discusses potential differences in elderly subjects compared with their younger counterparts and provides recommendations for clinical practice.