title: Management of acute heart failure in elderly patients.
abstract: Acute heart failure (AHF) is the most common cause of unplanned hospital admissions, and is associated with high mortality rates. Over the next few decades, the combination of improved cardiovascular disease survival and progressive ageing of the population will further increase the prevalence of AHF in developed countries. New recommendations on the management of AHF have been published recently, but as elderly patients are under-represented in clinical trials, and scientific evidence is often lacking, the diagnosis and management of AHF in this population is challenging. The clinical presentation of AHF, especially in patients aged>85years, differs substantially from that in younger patients, with unspecific symptoms, such as fatigue and confusion, often overriding dyspnoea. Older patients also have a different risk profile compared with younger patients: often heart failure with preserved ejection fraction, and infection as the most frequent precipitating factor of AHF. Moreover, co-morbidities, disability and frailty are common, and increase morbidity, recovery time, readmission rates and mortality; their presence should be detected during a geriatric assessment. Diagnostics and treatment for AHF should be tailored according to cardiopulmonary and geriatric status, giving special attention to the patient's preferences for care. Whereas many elderly AHF patients may be managed similarly to younger patients, different strategies should be applied in the presence of relevant co-morbidities, disability and frailty. The option of palliative care should be considered at an early stage, to avoid unnecessary and harmful diagnostics and treatments.
authors.affiliation: Geriatric Department, AP-HP, Saint Louis Lariboisière University Hospitals, Paris, France; INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France. Electronic address: antonio.teixeira@aphp.fr.
authors.forename: Antonio
authors.initials: A
authors.lastname: Teixeira
authors.affiliation: INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.
authors.forename: Mattia
authors.initials: M
authors.lastname: Arrigo
authors.affiliation: INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.
authors.forename: Heli
authors.initials: H
authors.lastname: Tolppanen
authors.affiliation: INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France; Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis Lariboisière University Hospitals, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.affiliation: INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France; Emergency Medicine Department, AP-HP, Saint Louis Lariboisière University Hospitals, Paris, France.
authors.forename: Said
authors.initials: S
authors.lastname: Laribi
authors.affiliation: Division of Cardiology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.affiliation: INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France; Division of Cardiology, Besancon University Hospital, Besancon, France.
authors.forename: Marie France
authors.initials: MF
authors.lastname: Seronde
authors.affiliation: INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France; Department of Cardiology, AP-HP, Saint Louis Lariboisière University Hospitals, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.affiliation: INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France; Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis Lariboisière University Hospitals, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015897:Comorbidity; D019091:Critical Pathways; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Acute heart failure; Diagnosis; Diagnostics; Elderly; Fragilité; Frailty; Insuffisance cardiaque aiguë; Palliative care; Personnes âgées; Soins palliatifs