The Recent Concept of Heart Function in Elderly Patients

An epidemic increase in heart failure (HF) mortality, hospitalization, and prevalence rates has been observed among older persons associated with increased an incidence and improved survival in recent years, in spite of a decrease in coronary artery and cerebrovascular disease mortality. Importantly, increases in HF mortality and morbidity rates were confi ned to the population over 65 years of age in the Framingham study. In contrast to middle-aged patients with HF, factors other than left ventricular (LV) systolic dysfunction contribute to HF in older patients. Epidemiological studies have established that 40 to 80 percent of older patients with heart failure, despite preserved ejection fraction without valve disease, are attributed to LV diastolic dysfunction. Keyword: geriatrics, elderly person, diastolic heart function, heart failure Introduction increase in heart failure (HF) mortality, hospitalization, and prevalence rates has been observed among older persons associated with an increased incidence and improved survival in recent years, in spite of a decrease in coronary artery and cerebrovascular disease mortality. 1 Importantly, increases in HF mortality and morbidity rates were confi ned to the population over 65 years of age in the Framingham study. 2 In contrast to middle-aged patients with HF, factors other than left ventricular (LV) systolic dysfunction contribute to HF in older patients. Epidemiological studies have established that 40 to 80 percent of older patients with heart failure, despite preserved ejection fraction without valve disease, are attributed to LV diastolic dysfunction. That is defi ned as diastolic heart failure (DHF). 3 Studies examining prevalence of diastolic heart failure in hospitalized patients or in patients undergo- ing outpatient diagnostic screening and prospective community based studies have shown that in patients greater than 70 years old, the prevalence of diastolic heart failure approaches 50%. 4-6 Although HF patients with preserved systolic function have a slightly better prognosis than HF patients with abnor- mal systolic function, there is a fourfold higher mortality risk compared with subjects free of HF. 7