Consensus of experts from the French Society of Geriatrics and Gerontology on the management of heart failure in very old subjects

• Published in: Archives of cardiovascular diseases 2021-03, Vol.114 (3), p.246-259
• Main Authors: Hanon, Olivier, Belmin, Joël, Benetos, Athanase, Chassagne, Philippe, De Decker, Laure, Jeandel, Claude, Krolak-Salmon, Pierre, Nourhashemi, Fati, Paccalin, Marc
• Format: Article
• Language: English
• Subjects: Age Factors; Aged, 80 and over; Cardiology; Cardiology - standards; Cardiovascular Agents; Cardiovascular Agents - adverse effects; Cardiovascular Agents - therapeutic use; Clinical Decision-Making; Comorbidity; Consensus; Decision Support Techniques; Elderly; Female; Frail Elderly; Geriatrics; Geriatrics - standards; Gériatrie; Health Status; Heart Failure; Heart Failure - diagnosis; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - physiopathology; Humans; Insuffisance cardiaque; Life Sciences; Male; Palliative Care; Prevalence; Quality of Life; Recovery of Function; Risk Assessment; Risk Factors; Sujet âgé; Treatment Outcome
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2020.12.001

The prevalence of heart failure increases with age. In France, the 1-year mortality rate is 35% in subjects aged 80–89 years with heart failure, and 50% after the age of 90 years. In octogenarians, heart failure is associated with high rates of cardiovascular and non-cardiovascular events, and is one of the main causes of hospitalization and disability. The prevalence of frailty increases in elderly subjects with heart failure, and the co-occurrence of heart failure and frailty increases the risk of mortality in patients with heart failure. In the elderly, the presence of frailty must be evaluated using a comprehensive geriatric assessment to manage geriatric syndromes, such as cognitive disorders, malnutrition, falls, depression, polypharmacy, disability and social isolation. The objective of heart failure therapy in octogenarians is to reduce symptoms, mortality and hospitalizations, but also to improve quality of life. In the absence of specific studies involving very old subjects, most recommendations are extrapolated from evidence-based data from younger populations. Overall, the epidemiological studies in patients with heart failure aged>80 years highlight the underprescription of recommended drugs. This underprescription may be related to comorbidity, a fear of side-effects and the lack of specific recommendations for drug prescription in heart failure with preserved ejection fraction, which is common in this very old population. The benefit/risk ratio related to heart failure treatment and comorbidity should be carefully weighed and reassessed on a regular basis. Consideration of disease prognosis according to factors that predict mortality can help to better define the care plan and promote palliative and supportive care when needed. La prévalence de l’insuffisance cardiaque (IC) augmente avec l’âge. En France, la mortalité à un an est de 35 % chez les insuffisants cardiaques âgés de 80 à 89 ans et de 50 % après 90 ans. Chez les octogénaires, l’IC est associée à un risque élevé d’événements cardiovasculaires, mais aussi d’événements non cardiovasculaires, elle représente ainsi l’une des principales causes d’hospitalisation et de perte d’autonomie. La prévalence de la fragilité augmente chez les sujets âgés insuffisants cardiaques et la fragilité augmente le risque de mortalité des insuffisants cardiaques. Chez les personnes âgées, l’existence d’une fragilité doit faire réaliser une évaluation gériatrique multidimensionnelle afin de prendre en char