A Practical Guide to Heart Failure in Older People

Description

Heart failure is effectively a disease of older people. Eighty percent of patients are over 65 years old, and the majority of these are over 75. This figure is likely to increase significantly in the next two decades. The prognosis is worse than that of most cancers and heart failure is the commonest reason for hospital admission in the over 65s.
The problems associated with treating heart failure in older patients are more diverse and complex than in those who are younger. The diagnosis in older patients is easily overlooked and as they were excluded from most heart failure treatment trials there has been a reluctance to treat them optimally (fewer than 20% are prescribed conventional medicines). They have multiple co-morbidities which are poorly managed, they are repeatedly hospitalised, and suffer social isolation.

These important age-related treatment and management problems have been largely ignored and this book aims to redress the balance. It provides a concise, comprehensive account of the epidemiology, pathogenesis, diagnosis, treatment, management and end-of-life care of elderly patients with heart failure, based on published studies.

A Practical Guide to Heart Failure in Older People is essential reading for geriatricians, cardiologists, general hospital physicians, family practitioners and specialist nurses.

• Specifically addresses the particular needs of the elderly, a largely ignored group who constitute the majority of patients with heart failure

• Presents a concise yet comprehensive account of the evidence relating to the diagnosis, treatment and management of heart failure in this population

• Improves awareness of the various roles within the management team

Table of Contents

Chapter 1 Introduction - Christopher Ward

• 1.1 A Working Definition of Heart Failure
• 1.2 What do We Mean by ‘Older People?’
• 1.3 The Expectations of Older Patients
• 1.4 Age-Related Problems in Heart Failure Treatment and Management
• 1.5 The Level of Evidence for Treating Older Patients
• References

Chapter 2 Epidemiology - Christopher Ward

• 2.1 Epidemiology, Demography and Prognosis
• 2.2 Heart Failure with Preserved Left Ventricular Systolic Function
• 2.3 Prevalence, Incidence and Prognosis
• 2.4 Age and Prognosis
• 2.5 The Effects of Gender and Race on Prevalence and Prognosis
• 2.6 The Increasing Prevalence of Heart Failure and Longevity
• 2.7 The Implications of Epidemiological and Demographic Data
• References

Chapter 3 Heart Failure and the Aging Heart - Helen Oxenham

• 3.1 Introduction
• 3.2 Overt and Subclinical Cardiovascular Disease in Older People
• 3.3 Mitral Annular Calcification
• 3.4 Age-Related Changes to Cardiac Structure and Function
• 3.5 Other Relevant Age-Related Changes
• 3.6 Responses of the Aging Cardiovascular System to Exercise, Normal Daily Activities and to Other Physiological Stresses
• 3.7 he Pathogenesis of Heart Failure
• 3.8 The Impact of Age-Related Changes to the Cardiovascular System on the Responses to Myocardial Damage
• 3.9 The Prevention of Heart Failure in Older People
• References

Chapter 4 Aetiology - Christopher Ward

• 4.1 Classification of the Aetiologies of Heart Failure
• 4.2 The Importance of Identifying the Aetiology
• 4.3 Specific Aetiologies
• 4.4 Post-Myocardial Infarction Heart Failure
• 4.5 Valvular Disease
• 4.6 The Cardiomyopathies
• 4.7 Atrial Fibrillation
• References

Chapter 5 Diagnosis - Christopher Ward

• 5.1 Diagnostic Guidelines
• 5.2 Symptoms and Signs: Sensitivity and Specificity
• 5.3 Objective Evidence of Left Ventricular Systolic Dysfunction
• 5.4 Diagnostic Difficulties in Older Patients
• 5.5 Diagnosis, Patient Management and Clinical Profile
• References

Chapter 6 Pharmacological Treatment - Miles D. Witham

• 6.1 Introduction
• 6.2 ACE Inhibitors
• 6.3 Beta-Blockers
• 6.4 Spironolactone
• 6.5 Diuretics
• 6.6 Digoxin
• 6.7 Hydralazine and Nitrates
• 6.8 Adding Angiotensin Receptor Blockers to ACE Inhibitors
• 6.9 Treating the Underlying Cardiovascular Disease
• 6.10 Medications to Avoid
• 6.11 Prescribing for Heart Failure with Preserved Systolic Function
• 6.12 Prescribing for Multiple Comorbidities
• 6.13 Prescribing at the End of Life
• References

Chapter 7 Non-Pharmacological Management - Sinéad P. McKee and Miles D. Witham

• 7.1 Exercise Training
• 7.2 Types of Exercise Programme
• 7.3 Smoking
• 7.4 Diet
• 7.5 Alcohol
• 7.6 Vaccinations
• 7.7 Psychological Interventions
• References

Chapter 8 Comorbidity - Andrew Elder

• 8.1 Introduction
• 8.2 The Prevalence of Comorbidities
• 8.3 The Implications of Comorbidity
• 8.4 Specific Comorbidities in Heart Failure
• References

Chapter 9 Treatment and Management in Primary Care - Alan Begg

• 9.1 Introduction
• 9.2 The Role of Primary Care and the Patient Population
• 9.3 Heart Failure Registers, Data Collection and Audit
• 9.4 Heart Failure in General Practice
• 9.5 Treatment and Management
• 9.6 Specific Problems in Treating Older Patients
• References

Chapter 10 The Role of the Specialist Nurse - Sinéad P. McKee

• 10.1 Introduction
• 10.2 The Role of the Specialist Nurse
• 10.3 Clinic-Based versus Home-Based Service
• 10.4 Multidisciplinary Team Liaison
• 10.5 Specific Issues Affecting Older Patients
• 10.6 End of Life Care
• 10.7 Specialist Nurses and Education
• References

Chapter 11 The Role of the Heart Failure Specialist - Maheshwar Pauriah, Aaron K.F. Wong and Chim C. Lang

• 11.1 Introduction
• 11.2 The Role of the Heart Failure Specialist
• 11.3 The Provision of a Diagnostic Service and Patient Assessment
• 11.4 Management of Patients with Acute or Worsening Heart Failure Symptoms
• 11.5 Optimization of Heart Failure Treatment
• 11.6 Treatment of Reversible Causes of Heart Failure
• 11.7 Treatment of Concomitant Diseases
• 11.8 Multidisciplinary Care
• References

Chapter 12 Hospitalization - Andrew Hannah

• 12.1 The Epidemiology of Hospitalization
• 12.2 The Aetiology of Heart Failure in Hospitalized Patients
• 12.3 Classification and Diagnosis of Acute Heart Failure
• 12.4 Causes and Precipitants of Hospitalization
• 12.5 Treatment of Acute Heart Failure
• 12.6 Management of the Common Cardiac Causes of Hospitalization for Heart Failure
• 12.7 Outcomes in Patients Hospitalized for Heart Failure
• 12.8 Strategies to Reduce Admissions and Readmissions in Patients with Heart Failure
• References

Chapter 13 Models of Care and Disease Management Programmes - Martin Wilson and Stephen J. Leslie

• 13.1 Introduction
• 13.2 Disease Management Programmes
• 13.3 Disease Management Programmes: The Evidence
• 13.4 Guidelines and Critical Care Pathways
• 13.5 Remote and Rural Issues
• 13.6 Telecardiology in Heart Failure
• 13.7 Conclusions
• References

Chapter 14 Palliative and Supportive care for Patients with Advanced and Terminal Heart Failure - Christopher Ward, Francis G. Dunn, Shona M.M. Jenkins and Martin Leiper

• 14.1 What is Palliative Care?
• 14.2 Age-Related Problems and the Provision of Palliative Care
• 14.3 Advanced and Terminal Heart Failure
• 14.4 Management of Specific Symptoms
• 14.5 Home and Hospital Care
• 14.6 Withdrawal of Conventional Drugs
• 14.7 The Palliative Care Needs of Heart Failure Patients
• 14.8 Palliative Care Strategies for Heart Failure
• 14.9 Timing the Introduction of Different Palliative Care Strategies
• 14.10 Cardiological Issues
• 14.11 The Management Implications of Advanced Heart Failure
• 14.12 Control of Symptoms Using Mostly Generic Treatments
• 14.13 Support in the Community: The Gold Standard Framework and Advanced Care Planning
• 14.14 Terminal Heart Failure: Identifying the Dying Patient and Providing End-of-Life Care
• References