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Heart Failure in the Elderly
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What is the problem and what is known about it so far?
Heart failure is an inability of the heart muscle to pump blood through the heart in a normal manner. It is one of the most common and serious illnesses in the United States, particularly in older adults. Typically, heart failure occurs when the lower chambers of the heart (ventricles) do not fill or empty blood properly. Problems with abnormal filling are often called diastolic heart failure, while problems with abnormal emptying are called systolic heart failure. Older adults often have heart failure with abnormal filling and normal emptying (so-called diastolic heart failure). An important unanswered question is whether older patients with diastolic heart failure do better and live longer than those with systolic heart failure.
Why did the researchers do this particular study?
To describe outcomes of different types of heart failure in older adults.
Who was studied?
5532 men and women older than 65 years of age from four U.S. communities. Their average age was about 74 years.
How was the study done?
During 1989 to 1990 and 1992 to 1993, the researchers recruited people from Maryland, North Carolina, California, and Pennsylvania for their study. These people answered questions about their medical history, heart and lung symptoms, and medications. They had physical examinations, blood tests, heart tracings, chest x-rays, and heart ultrasound tests (echocardiography). The researchers diagnosed heart failure based on symptoms, physical examination, x-rays, and medication use. The researchers used the echocardiography results to sort the older adults into groups with normal or abnormal emptying of the left side of the heart (that is, normal or abnormal left ventricular systolic function). The researchers contacted patients every 6 months for about 6 years. They reviewed medical records, hospitalizations, and death certificates. They then compared death rates among people with and without heart failure and with and without abnormal systolic function.
What did the researchers find?
About 5% of the older adults had heart failure. Forty-five percent of those with heart failure died within 6 to 7 years. Only 16% of those without heart failure died during this time. Systolic function of the heart was normal (63%), borderline decreased (15%), or clearly abnormal (22%) among the patients with heart failure. Patients with heart failure and abnormal systolic function had higher death rates than patients with heart failure and normal systolic function, although the death rates for the latter group were still much higher than those for persons without heart failure or impaired systolic function.
What were the limitations of the study?
Diastolic heart failure is hard to diagnose. The researchers had to presume that patients with heart failure and normal systolic function on echocardiography had diastolic failure.
What are the implications of the study?
In older adults, heart failure with normal systolic function is much more common than failure with abnormal systolic function but has a lower death rate. Older adults with either type of heart failure have higher risks for dying than older adults without heart failure.
Article and Author Information
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The summary below is from the full report titled “Outcome of Congestive Heart Failure in Elderly Persons: Influence of Left Ventricular Systolic Function. The Cardiovascular Health Study.” It is in the 15 October 2002 issue of Annals of Internal Medicine (volume 137, pages 631-639). The authors are JS Gottdiener, RL McClelland, R Marshall, L Shemanski, CD Furberg, DW Kitzman, M Cushman, J Polak, JM Gardin, BJ Gersh, GP Aurigemma, and TA Manolio.
- Copyright ©2004 by the American College of Physicians
