Prognosis By Ejection Fraction
Ejection fraction is a measure of how much blood is pumped out of your heart each time it contracts. A healthy heart has an EF of between about 55 percent to 75 percent.
Some people with CHF have a reduced EF. This means their heart is pumping less blood out to the rest of their body than a healthy heart. Studies have shown that people who have CHF and a reduced EF have a more challenging outlook than people with CHF who do not have a reduced EF.
The exact survival rates varied among studies, but have shown that EF has an impact on prognosis. Your doctor will have the best information about how your ejection fraction can affect your prognosis.
How Well Do Heart Transplants Work
Transplants are not always the best treatment for older patients, and the demand for donor hearts always outpaces supply. But were doing more heart transplants at UChicago Medicine, and Im happy to see them saving more lives. Were seeing big improvements in survival rates. The average survival rate is now over 11 years. Twenty years ago, the idea that someone could live 20 or 30 years with a transplanted heart was a fantasy. Not anymore.
Is Heart Disease Irreversible For Older Adults
As a clinical condition, yes, heart disease cannot be completely eliminated for patients of any age. However, we have treatments that can make it better. Its a progressive illness, and its not something we can cure, but we can slow it down. It can progress so slowly so it doesnt seem like its progressing at all.
Sean Pinney, MD, is one of the nations leading experts in heart failure and heart transplants. Hes Co-Director of UChicago Medicines Heart & Vascular Center, and Director of Advanced Heart Failure, Transplant and Mechanical Circulatory Support. He also serves on the board of directors for the Geriatric Cardiology Consortium in New York.
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Factors Responsible For Prevalence Of Chf
The exponential increase in the prevalence of CHF with advancing age can be attributed to the increase in the prevalence and cumulative duration of systemic hypertension with advancing age, the increase in the prevalence and duration of coronary artery disease with advancing age, and perhaps age-related changes in cardiac structure and function, which occur even in the absence of cardiovascular disease.
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Where Are We Now What Remains To Be Done
Thus, RCTs have yielded limited evidence of the efficacy of medical treatment in elderly patients with HF. However, though there are still uncertainties regarding treatment of patients with HFPEF, we have no data suggesting that therapies shown to be beneficial in RCTs should have a different effect in elderly subjects with HF and low LVEF. Subgroup analyses have never shown a conclusive interaction between age and the effects of treatment on outcomes in RCTs. Thus, elderly patients with HF caused by LV systolic dysfunction should be treated with the same medications shown to be effective in the overall population of patients with HF. The only differences are related to the greater incidence of side effects and lower tolerability of these agents in elderly subjects and, probably more importantly, to difficulties in their administration related to lack of compliance, co-morbidities, and lack of support for some of them. More importantly, however, is that so far no treatment has been shown to improve outcomes in patients with HFPEF, who comprise the majority of elderly patients, and this remains a critical unmet need.
Conflict of interest: none declared.
Concise Review For Primary
The prevalence of is increasing. Most patients with CHF are elderly, and CHF is the most common dismissal diagnosis in elderly hospitalized patients. As many as 50% of elderly patients with heart failure may have normal and isolated . Assessment and management of elderly patients are complicated by comorbidities, increased susceptibility to side effects, and concerns about the appropriate use of costly and invasive procedures. The basics of the approach to the evaluation and management of heart failure in elderly patients are reviewed.
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Can Taking Too Many Medications Impact Older Adults With Heart Failure
Yes. As we age, the body doesnt handle the medicine in the same way. It metabolizes medicines differently, which is why taking too many medications can be a problem for older patients with heart failure. As we age, the liver and kidneys dont work as well, so drugs can sometimes build up in the system. Older people on medicines for their heart might be on five, six or 10 other drugs. So theyre taking a whole cocktail of medicines that might not work well together and could have side effects. Its helpful to re-prioritize medications with your doctor. Over-the-counter pain medications can sometimes be very dangerous in older people because they can raise blood pressure and harm the kidneys. They can also have a sedative effect on people and cause delirium.
How Home Care Can Help Manage Congestive Heart Failure In Seniors
A skilled caregiver can make a huge difference in the quality of life for a person with CHF. A few of the numerous ways they can provide support include:
- Grocery shopping and preparing heart-healthy meals
- Providing transportation to doctor appointments
- Motivating and encouraging the senior to stick to a fitness program
- Making sure medications are taken exactly how and when they are prescribed
- Providing friendly companionship to alleviate isolation and loneliness
Get in touch with Inspired Home Care, one of the top homecare agencies in Chicago and the surrounding areas, at to learn more about how our trusted senior care services can make every day the very best it can be for someone with CHF.
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What Are The Signs Of Heart Failure In Older Adults
People with heart failure typically feel an overwhelming sense of fatigue. Theyll find they may have shortness of breath while doing daily activities, like getting dressed, bathing or even putting on their shoes. Heart failure patients may also have swelling in their legs or abdomen that doesnt improve, even with a normal dose of diuretic water pills. They also may need to prop themselves up with extra pillows to breathe more easily, which is a symptom of congestion because their body is filling up with fluids.
What New Treatments Are On The Horizon
Im very excited about what the digital age will ultimately allow us to do with respect to new heart failure treatments. Soon we will have access to miniature devices that can be implanted into a persons body without needing surgery. Theyll help a failing heart or kidney by reshaping the organ to help it function properly. There is also a lot of research on remote monitoring devices that can detect and prevent heart failure before it starts. The new technology will include very tiny implantable, ingestible or wearable devices that let doctors see in real time what a persons heart pressures are. Artificial intelligence will interpret the collected data, which will give doctors a better picture of whats happening than a one-time test in the doctors office. Then well be able to help control heart problems remotely just by adjusting medications or giving individualized therapies. Where well be in five to 10 years with this is really exciting. There are also medicines in the pipeline that will help increase survival for people with heart failure.
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The Background: Heart Failure As A Disease Of The Elderly
HF is predominantly a disease of the elderly. The mean age of HF patients is > 70 years in most developed countries, and the prevalence of HF rises dramatically with age, from 12% among individuals aged 4554 years to > 10% among those aged 75 years. Ageing predisposes to HF through multiple mechanisms. First, HF is a frequent outcome of virtually all cardiovascular diseases. Hence, patients with most cardiovascular diseases are prone to developing ventricular remodelling and HF when elderly. Secondly, even in the absence of any cardiovascular event, ageing is associated with reduced aortic and left ventricular compliance, with increased aortic impedance and abnormal LV diastolic function. These conditions lower the threshold for the development of HF when the heart is exposed to precipitating factors such as hypertension and/or tachyarrhythmias .
How To Live With Congestive Heart Failure
The American Heart Association recommends moderately strenuous aerobic activity for a minimum of 30 minutes per day, 5 days a week, for maximum heart health. Still, it is important to check with the doctor for specific recommendations. In particular, note that exercising should never result in breathlessness for those with CHF.
Other important lifestyle modifications to slow the advancement of the disease include:
- Observing a low- or reduced-salt diet
- Avoiding alcohol and smoking
- Keeping a healthy body weight
- Keeping blood pressure levels under control
- Getting enough sleep
- Minimizing stress
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Prognosis At Each Stage
The outlook for CHF varies greatly between people, as there are many contributing factors for every individuals situation. However, generally speaking, if CHF is discovered in its earlier stages and properly managed, you can expect a far better outlook than if its discovered much later.
Some people whose CHF is discovered early and treated promptly and effectively can hope to have a nearly standard life expectancy.
What You Need To Know About Heart Failure Treatment For The Elderly
Heart failure is a cardiac condition where the heart does not pump blood as efficiently as it should, resulting in a lack of oxygen and nutrients throughout the body. Though it affects people of all ages, heart failure is the leading cause of hospitalizations in people older than 65. Elderly patients who experience heart failure are likely to already have a chronic cardiovascular condition, but it can also be caused by physical decline due to aging and poor cardiovascular management throughout life. Other risk factors include obesity, a family history of heart failure, hypertension and diabetes.
Early signs of heart failure in the elderly are similar to those found in other age groups, which include worsening or shortness of breath, fatigue, bloating, lack of appetite, persistent cough, lack of appetite and nausea. Other symptoms may include a mental decline or depression.
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Heart Failure Treatment Options For The Elderly
Heart failure is always treated with a combination of medication and lifestyle changes, but some elderly heart failure patients may benefit from a cardiac rehabilitation program, particularly if theyve experienced a cardiac event such as a heart attack.
Surgical options for older people with heart failure can be limited. For example, most elderly patients arent considered good candidates for heart transplants, as the cutoff to receive a heart transplant is age 70. However, a surgically-implanted left ventricular assist device, or LVAD, can be an option for elderly heart failure patients into their 80s. The LVAD is an implantable mechanical pump that pumps blood from the lower chambers of your heart to the rest of your body. This often improves heart failure, and in some cases, reverses it altogether.
Congestive Heart Failure Treatment
Congestive heart failure is a medical condition that occurs when the heart cannot pump blood effectively. There are many different treatments for this condition. These treatments may include Coronary artery bypass surgery, ACE inhibitors, blood tests, and sleep apnea. The goal of congestive heart failure treatment is to treat the underlying cause of the condition and to improve the quality of life for the patient.
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What Are The Stages Of Chf
There are 4 main stages of congestive heart failure:
Individuals at risk for developing congestive heart failure as a result of having a family history of cardiomyopathy, early coronary artery disease, high blood pressure, or diabetes are considered in the earliest stage of the disease. At this stage, lifestyle changes are important to stop CHF from developing. This could include exercise, dietary changes, and medication.
In this stage, there are some signs of changes to the heart that could lead to CHF. There could have been a preceding heart attack or heart valve disease, or elevated blood pressure might be diminishing heart health. Treatment includes the lifestyle adjustments for Stage A, and also possible surgery or other treatment for heart valve disease, heart attack, or artery blockage.
Stage C is considered the first stage in which CHF is officially diagnosed. Symptoms include inflammation in the legs, shortness of breath , and the inability to exercise. Cardiac rehabilitation and medications can help enhance quality and duration of life for those in Stage C.
When a person reaches Stage D, the options include a heart transplant or mechanical heart pump. It is imperative to see a heart specialist as soon as possible upon receiving a Stage D CHF diagnosis to determine the optimum treatment plan.
Which Are The Desired Effects What Is The Evidence For Treatment In The Elderly
Ageing is clearly attended by a shift in the primary aim of treatment from duration of life to quality of life. However, duration of life remains an important target in elderly patients too. The benefits of recommended therapies are, however, not so clearly shown by RCTs, and there is a discrepancy between the patients studied in these trials and real patients with HF. Even if patients with HF have a mean age of 75 years, the evidence for current treatment is based on RCTs including patients with a mean age of 60 years, with generally only < 30% of the patients older than 70 years.
With respect to the first cornerstone of medical treatment of HF, the angiotensin-convertng enzyme inhibitors , the results in elderly patients with HF are rather controversial. A relatively recent meta-analysis failed to show a significant effect of ACEIs on outcomes in the subgroup of patients aged > 75 years. This result, however, appears to be a function of the low number of elderly patients included in trials since no significant interaction between age and the benefits of ACEIs was found.
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Can Loneliness Impact Heart Disease
Yes. Loneliness can accelerate chronic illnesses and have a negative impact on the heart, and even lead to heart disease, which is a precursor to heart failure. Loneliness can lead people to not eat or take care of themselves. Its also important to have companionship for both emotional and safety reasons. To avoid isolation, older adults can use support groups to help them socialize. During COVID-19, they have to do this cautiously, with masks and social distancing, or via video. Connecting with others helps alleviate depression, sleep disturbances and feeling no pleasure in life.
Coronary Artery Bypass Surgery
This surgery restores the hearts ability to pump blood, and is usually done in an intensive care unit. Before the procedure, the patient will undergo diagnostic tests and a review of their medical history. A breathing tube will be placed in the chest to help the patient breathe. After the surgery, the patient will be placed on a cardiac monitoring machine and may need to undergo periodic blood transfusions.
A heart bypass surgery can take anywhere from six to twelve weeks to complete. Its important to rest after surgery and avoid heavy exercise or driving until the doctor gives the green light. The surgery can also cause memory loss in patients, though this is usually temporary and usually improves within six months to a year. The surgery can also lead to a stroke or a sternum infection, although these are rare complications.
The procedure is performed under general anesthesia. It generally takes three to six hours. During this procedure, a surgeon divides the chestbone to access the heart. The internal mammary artery is also separated from the chest wall. An artery or vein from the arm or leg is then cut and attached to the blocked coronary artery. The heart is temporarily stopped with chemicals while the graft is attached.
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How Do You Treat Advanced Stage Heart Failure In Older Adults
At UChicago Medicine, the cornerstone of our heart failure therapy is first-in-class medications that have been shown to improve and extend life. For more serious cases, we can provide heart transplants, ventricular assist devices or a continuous infusion of inotropes, which are medicines that help the heart pump blood and can sustain people for many months or years. We also offer access to experimental therapies and drugs.
How Important Is Exercise And Resistance Training For Seniors
Things like exercise and strength training will help prevent heart failure. People can get in shape no matter how old they are. Its a matter of going out there every day, and stretching so the muscles and joints are loose and flexible. No matter how old a person is, they can build muscle. Thats important, because after age 55, a person begins to lose muscle mass. So its important for older people to lift weights, exercise and keep their aerobic capacity up.
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Stage A Treatment Options
Treatment options in stage A mainly focus on promoting your overall health and disease prevention. If you meet the stage A criteria, your doctor will recommend lifestyle changes to slow or stop disease progression.
Heart Failure Doctor Discussion Guide