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F. Guerra [1] and M. Brambatti [1] and M. V. Matassini [1] and A. Capucci [1]

Academic Editor: Natale Daniele Brunetti

Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Ancona, Italy, univpm.it

Received Aug 14, 2017; Revised Oct 25, 2017; Accepted Oct 29, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Drug Therapy

Several issues must be considered in HF elderly patients undergoing pharmacological treatment. First, these patients suffer from multiple chronic diseases, which increase the likelihood of adverse drug reactions (hypotension, kidney dysfunction, and electrolytic disturbances) and often prevent the optimal recommended treatment, as is the case with severe chronic obstructive pulmonary disease and β-blockers. Also, patients with HF take many medications, which further increase the risk of adverse drug events and drug-drug interactions. Moreover, drugs pharmacokinetics and pharmacodynamics are influenced by age-related physiological changes of volume distribution. These aspects, in combination with the reduction in drug clearance, may affect to some extent the drug plasma concentration at steady-state, increasing the risk of drug accumulation and its side effects. Finally, the therapeutic plan may be affected by the age-related cognitive impairment, as well as social and economic factors, which impair the adherence to the medication regimen. Due to all the above reasons, several findings showed that elderly patients with HF had lower guideline based medical treatment prescription rates at discharge compared to younger patients [1–3].

To date, limited evidence has investigated the effects of the recommended systolic HF therapies in aged patients [4] (Table 1). However, data from small observational studies and substudies suggest that elderly patients derive similar benefits as younger patients [5–7].

Table 1

Major randomized clinical trials on HF drug therapy and elderly population.

Drug class Trial Patients number Mean age (years) Patients age ≥ 65 Patients age > 70 Primary endpoint RRR (%) Age interaction
ACE inhibitors SAVE [22](captopril versus placebo) 2231 59 35% 15% 19% all-cause mortality No(<55 versus 55–64 versus >65)
SOLVD [21](enalapril versus placebo) 2569 61 — — 16% all-cause mortality —
ATLAS [20](lisinopril low versus high...
 
 
 
     
 
   
 
   
 

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