Heart Failure in the Elderly

Heart failure is a clinical syndrome with various causes for which no universally accepted definition exists. Packer's definition of heart failure "representing a complex clinical syndrome characterised by abnonnalities of left ventricular function and neurohumoral regulation. which are accompanied by effort intolerance, fluid retention and reduced longevity" reveals the complexity of the syndrome. Heart failure is one of the commonest cardiovascular disorders in Western Society and a growing major public health problem. It has been estimated that in the Netherlands the number of hospital discharges for heart failure rose from 14441 in 1980 to 25966 in 1993. The prevalence of heart failure rises rapidly with age from 0.7% in those aged 55-64 to 13.0% in those aged 74-84.4 This indicates a rapidly expanding problem mainly due to an increase in the number of elderly. Despite the facl that heart failure and its precursor left ventricular systolic dysfunction are increasingly being recognised as important causes for morbidity and mortality, epidemiologic data are scarce. l For example, reliable information on the incidence of the syndrome is very limited. One of the reasons of the lack of epidemiologic data on heart failure is the difficulty of diagnosing early slages of heart failure and the virtual absence of target cohort studies. In the Netherlands and in the UK most heart failure patients are detected and treated in general practice. Heart failure is difficult to diagnose by the general practitioner due to the unavailability of morc sophisticated or invasive diagnostic tools and is primarily based on clinical judgement. In recent years neurohumoral and Doppler echocardiographic measurements have emerged as noninvasive tools that could aid in the diagnosis of heart failure, also in a non-hospital setting. Heart fallure carries a poor prognosis, but, again, data from population-based studies, notably those addressing the prognostic implications of asymptomatic ventricular dysfullction, is limited.

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