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Individualizing the care of older heart failure patients

Heckman, George, A.a; McKelvie, Robert, S.b; Rockwood, Kennethc

Current Opinion in Cardiology: March 2018 - Volume 33 - Issue 2 - p 208–216
doi: 10.1097/HCO.0000000000000489
HEART FAILURE: Edited by Haissam Haddad

Purpose of review The heart failure epidemic is driven mainly by population aging and the improving survival of patients with cardiovascular risk factors. Aging heart failure patients are affected by multiple concurrent comorbidities and geriatric syndromes, the most important of which are frailty and cognitive impairment. The purpose of this review is to provide clinicians with practical advice on how to individualize the care of older heart failure patients.

Recent findings Frailty and cognitive impairment are common in older heart failure patients. Frailty is increasingly recognized as a key risk factor for functional decline, health service utilization and mortality in aging heart failure patients. Similarly, cognitive impairment impairs patients’ ability for self-care and leads to adverse outcomes. Simple and efficient instruments exist to screen for these conditions. Heart failure patients who are frail or cognitively impaired are best looked after in a disease management setting that is deployed in a more integrated healthcare system with access to specialized geriatric consultants. Optimal care planning requires knowledge of these conditions as well as patient and caregiver engagement.

Summary Frailty and cognitive impairment are central features of the heart failure syndrome in aging patients and should be routinely considered in assessment and care planning.

aResearch Institute for Aging, School of Public Health and Health Systems, University of Waterloo

bSchulich School of Medicine and Dentistry, Western University in London, Ontario

cDivision of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

Correspondence to George A. Heckman, MD, MSc, FRCPC, Schlegel Research Chair in Geriatric Medicine, Research Institute for Aging, Associate Professor, School of Public Health and Health Systems, University of Waterloo, LHN 3706, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada. Tel: +1 519 888 4567 31028; e-mail: ggheckman@uwaterloo.ca

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