Is there hope that heart failure will improve even in old age?

Is there hope that heart failure will improve even in old age?

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OfMassimo Mapelli

The chronological age, especially if considered alone, does not represent a valid criterion of choice for excluding the elderly from potentially effective therapies. Which ones are available today

I am a 90 year old man and I suffer from heart failure: are there any cases in which the conditions of this pathology can improve, even in old age?

He replies Massimo Mapelli, Department of Critical Cardiology, Card Center. Monzino; University of Milan (GO TO THE FORUM)

The aging of the general population – an idea with which we have long since become familiar – is invariably accompanied by an increase in fragile subjects suffering from chronic diseases more or less associated with each other (a concept that is usually referred to as “comorbidity”). In this context, heart failure – a disease that afflicts 2% of the Italian population and around 20% of people over 80 years of age – plays a key role, given the important repercussions on the health of our older fellow citizens and, last but not least, on healthcare spending. This is the most frequent discharge diagnosis from internal hospital departments and affects subjects of both sexes, albeit with different trends.

Available therapies

In fact, in proportion, the increased incidence observed in older women presents peculiar clinical characteristics compared to forms of heart failure that are more frequent in “young” and male subjects, usually affected by post-infarction forms. The most recent data in our possession demonstrates a clear beneficial effect of many heart failure therapies (for example beta blockers, gliflozine, neurohormonal inhibitors such as sacubitril/valsartan), effective in significantly improving the quality of life. This evidence comes from clinical studies conducted on thousands of patients and is extremely robust. A large sample, sure, but that is unfortunately lacking in octogenarians and in which males are more represented. In general terms, today we have much more powerful weapons in our hands than in the past to reverse the inexorable worsening trend of chronic diseases, also designed for the most fragile.

Genetic heritage

However, it remains fundamental best characterize our patientsframing them globally with their comorbidities, if present.
Adding to these data some clinical variables useful for the evaluation of decompensation (echocardiographic data, blood chemistry tests, exercise capacity) it is possible to estimate the prognosis with considerable precision. Not at least, a certain advantage in terms of genetic heritage, although difficult to quantify, is often observable in subjects who are in excellent condition despite their advanced age. For this reason, as reported in many international guidelines, chronological age, especially if considered alonedoes not represent a valid criterion of choice for excluding the elderly from potentially effective therapies.

March 27, 2024

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