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Tersalvi G, Gasperetti A, Schiavone M, Dauw J, Gobbi C, Denora M, Krul JD, Cioffi GM, Mitacchione G, Forleo GB. Acute heart failure in elderly patients: a review of invasive and non-invasive management. J Geriatr Cardiol 2021; 18:560-576. [PMID: 34404992 PMCID: PMC8352772 DOI: 10.11909/j.issn.1671-5411.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute heart failure (AHF) is a major cause of unplanned hospitalisations in the elderly and is associated with high mortality. Its prevalence has grown in the last years due to population aging and longer life expectancy of chronic heart failure patients. Although international societies have provided guidelines for the management of AHF in the general population, scientific evidence for geriatric patients is often lacking, as these are underrepresented in clinical trials. Elderly have a different risk profile with more comorbidities, disability, and frailty, leading to increased morbidity, longer recovery time, higher readmission rates, and higher mortality. Furthermore, therapeutic options are often limited, due to unfeasibility of invasive strategies, mechanical circulatory support and cardiac transplantation. Thus, the in-hospital management of AHF should be tailored to each patient's clinical situation, cardiopulmonary condition and geriatric assessment. Palliative care should be considered in some cases, in order to avoid unnecessary diagnostics and/or treatments. After discharge, a strict follow-up through outpatient clinic or telemedicine is can improve quality of life and reduce rehospitalisation rates. The aim of this review is to offer an insight on current literature and provide a clinically oriented, patient-tailored approach regarding assessment, treatment and follow-up of elderly patients admitted for AHF.
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Affiliation(s)
- Gregorio Tersalvi
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Alessio Gasperetti
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Marco Schiavone
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Cecilia Gobbi
- Institut Cardiovasculaire de Caen, Hôpital Privé Saint Martin, Caen, France
| | - Marialessia Denora
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Joel Daniel Krul
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Giacomo Maria Cioffi
- Division of Cardiology, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Gianfranco Mitacchione
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Giovanni B. Forleo
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
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Kimmoun A, Takagi K, Gall E, Ishihara S, Hammoum P, El Bèze N, Bourgeois A, Chassard G, Pegorer-Sfes H, Gayat E, Solal AC, Hollinger A, Merkling T, Mebazaa A. Temporal trends in mortality and readmission after acute heart failure: a systematic review and meta-regression in the past four decades. Eur J Heart Fail 2021; 23:420-431. [PMID: 33443295 DOI: 10.1002/ejhf.2103] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/21/2020] [Accepted: 01/10/2021] [Indexed: 12/26/2022] Open
Abstract
AIMS Acute heart failure (AHF) is frequent and life-threatening disease. However, innovative AHF therapies have remained limited, and care is based on experts' opinion. Temporal trends and benefits of long-term oral cardiovascular medications on AHF outcomes remain uncertain. METHODS AND RESULTS This study is registered with PROSPERO (CRD42018099885). A systematic review ranging from 1980 to 2017, searched AHF studies with more than 100 patients that reported death and/or readmission. Primary outcomes were temporal trends, assessed by meta-regression, for 30-day or 1-year all-cause death and/or readmission rates. Secondary outcomes were temporal trends of oral cardiovascular therapies and their influence on primary outcomes. Among the 45 143 studies screened, 285 were included, representing 15 million AHFs. In the past decades, though mortality and readmission remain high, there was a decline in 30-day all-cause death [odds ratio (OR) for a 10-year increment: 0.74, 95% confidence interval (CI) 0.61-0.91; P = 0.004] that persisted at 1 year (OR 0.86, 95% CI 0.77-0.96; P = 0.007), while 30-day and 1-year all-cause readmission rate remained roughly unchanged. Trends of primary outcomes were linear and did not differ among continents. Decline in 1-year all-cause death rate correlated with high proportions of oral or beta-blockers, especially when combined with oral renin-angiotensin-aldosterone system inhibitors, but not with diuretics while trends in readmission remained unchanged with these therapies. CONCLUSIONS Although AHF outcomes remain poor, the present study revealed global favourable trends of survival after AHF episodes probably associated with greater use of oral neurohormonal antagonists. The present study urges to implement the combination of oral renin-angiotensin-aldosterone system inhibitors and beta-blockers in patients at risk of AHF.
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Affiliation(s)
- Antoine Kimmoun
- Université de Lorraine, CHRU de Nancy, Intensive Care Medicine Babois, FCRIN INI-CRCT, Nancy, France.,INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Paris, France
| | - Koji Takagi
- INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Paris, France
| | - Emmanuel Gall
- Department of Cardiology, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris; Université de Paris, Paris, France
| | - Shiro Ishihara
- INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Paris, France.,Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Pierre Hammoum
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - Nathan El Bèze
- Intensive and Toxicologic Care Medicine, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris; Université Paris Diderot - Paris 7, Sorbonne Paris Cité, Paris, France
| | - Alexandre Bourgeois
- Université de Lorraine, CHRU de Nancy, Intensive Care Medicine Babois, FCRIN INI-CRCT, Nancy, France
| | - Guillaume Chassard
- Université de Lorraine, CHRU de Nancy, Intensive Care Medicine Babois, FCRIN INI-CRCT, Nancy, France
| | - Hugo Pegorer-Sfes
- Université de Lorraine, CHRU de Nancy, Intensive Care Medicine Babois, FCRIN INI-CRCT, Nancy, France
| | - Etienne Gayat
- INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Paris, France.,Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - Alain C Solal
- INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Paris, France.,Department of Cardiology, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris; Université de Paris, Paris, France
| | - Alexa Hollinger
- INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Paris, France.,Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Thomas Merkling
- Université de Lorraine, Inserm 1433 CIC-P CHRU de Nancy, Inserm U1116 and FCRIN INI-CRCT, Nancy, France
| | - Alexandre Mebazaa
- INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Paris, France.,Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
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