A Practical Guide to Heart Failure in Older People

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ISBN: 9780470695173 | 047069517X
Cover: Hardcover
Copyright: 5/18/2009

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The objectives of treating and managing patients with heart failure are in many respects independent of age, but the management of older patients is more difficult and more complex than in younger patients: The diagnosis is easily overlooked, they have multiple co morbidities which are poorly managed, are repeatedly hospitalised, and suffer social isolation. Furthermore, they were excluded from most heart failure treatment trials as a result of which there has been a reluctance to treat them optimally as a result of which less than 20% are prescribed conventional medicines.The aim of this book is to redress the balance. It will provide 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 and on expert opinion: It will be a practical guide, not a reference manual.One of the main reasons for proposing this book is the heterogeneity of care for older people with heart failure combined with the wide spectrum of health care professionals involved in the process, no one group of professionals has all of the expertise needed to address all the needs of this group of patients and this book will help increase awareness of their respective roles.

Preface	p. xi
List of Contributors	p. xiii
Introduction	p. 1
A Working Definition of Heart Failure	p. 1
What do We Mean by 'Older People?'	p. 2
The Expectations of Older Patients	p. 4
Age-Related Problems in Heart Failure Treatment and Management	p. 4
The Level of Evidence for Treating Older Patients	p. 6
References	p. 7
Epidemiology	p. 9
Epidemiology, Demography and Prognosis	p. 9
Heart Failure with Preserved Left Ventricular Systolic Function (HF-PSF)	p. 10
Prevalence, Incidence and Prognosis	p. 11
Age and Prognosis	p. 14
The Effects of Gender and Race on Prevalence and Prognosis	p. 18
The Increasing Prevalence of Heart Failure and Longevity	p. 19
The Implications of Epidemiological and Demographic Data	p. 20
References	p. 22
Heart Failure and the Aging Heart	p. 27
Introduction	p. 27
Overt and Subclinical Cardiovascular Disease in Older People	p. 28
Age-Related Changes to Cardiac Structure and Function	p. 33
Other Relevant Age-Related Changes	p. 35
Responses of the Aging Cardiovascular System to Exercise, Normal Daily Activities and to Other Physiological Stresses	p. 36
The Pathogenesis of Heart Failure	p. 38
The Impact of Age-Related Changes to the Cardiovascular System on the Responses to Myocardial Damage	p. 40
The Prevention of Heart Failure in Older People	p. 40
References	p. 41
Aetiology	p. 45
Classification of the Aetiologies of Heart Failure	p. 45
The Importance of Identifying the Aetiology	p. 47
Specific Aetiologies	p. 48
Post-Myocardial Infarction (Post-MI) Heart Failure	p. 49
Valvular Disease	p. 51
The Cardiomyopathies	p. 56
Atrial Fibrillation	p. 57
References	p. 58
Diagnosis	p. 63
Diagnostic Guidelines	p. 64
Symptoms and Signs: Sensitivity and Specificity	p. 65
Objective Evidence of Left Ventricular Systolic Dysfunction	p. 66
Diagnostic Difficulties in Older Patients	p. 70
Diagnosis, Patient Management and Clinical Profile	p. 73
References	p. 76
Pharmacological Treatment	p. 79
Introduction	p. 79
ACE Inhibitors	p. 81
Beta-Blockers	p. 83
Spironolactone	p. 85
Diuretics	p. 87
Digoxin	p. 88
Hydralazine and Nitrates	p. 89
Adding Angiotensin Receptor Blockers to ACE Inhibitors	p. 90
Treating the Underlying Cardiovascular Disease	p. 90
Medications to Avoid	p. 90
Prescribing for Heart Failure with Preserved Systolic Function	p. 92
Prescribing for Multiple Comorbidities	p. 92
Prescribing at the End of Life	p. 93
References	p. 93
Non-Pharmacological Management	p. 97
Exercise Training	p. 97
Types of Exercise Programme	p. 98
Smoking	p. 100
Diet	p. 101
Alcohol	p. 103
Vaccinations	p. 104
Psychological Interventions	p. 104
References	p. 104
Comorbidity	p. 107
Introduction	p. 107
The Prevalence of Comorbidities	p. 109
The Implications of Comorbidity	p. 109
Specific Comorbidities in Heart Failure	p. 111
References	p. 127
Treatment and Management in Primary Care	p. 133
Introduction	p. 134
The Role of Primary Care and the Patient Population	p. 134
Heart Failure Registers, Data Collection and Audit	p. 135
Heart Failure in General Practice	p. 140
Treatment and Management	p. 146
Specific Problems in Treating Older Patients	p. 150
References	p. 152
The Role of the Specialist Nurse	p. 157
Introduction	p. 157
The Role of the Specialist Nurse	p. 158
Clinic-Based versus Home-Based Service	p. 163
Multidisciplinary Team Liaison	p. 165
Specific Issues Affecting Older Patients	p. 166
End of Life Care	p. 169
Specialist Nurses and Education	p. 169
References	p. 171
The Role of the Heart Failure Specialist	p. 175
Introduction	p. 175
The Role of the Heart Failure Specialist	p. 176
The Provision of a Diagnostic Service and Patient Assessment	p. 177
Management of Patients with Acute or Worsening Heart Failure Symptoms	p. 178
Optimization of Heart Failure Treatment	p. 180
Treatment of Reversible Causes of Heart Failure	p. 184
Treatment of Concomitant Diseases	p. 187
Multidisciplinary Care	p. 189
References	p. 191
Hospitalization	p. 197
The Epidemiology of Hospitalization	p. 197
The Aetiology of Heart Failure in Hospitalized Patients	p. 198
Classification and Diagnosis of Acute Heart Failure (AHF)	p. 199
Causes and Precipitants of Hospitalization	p. 201
Treatment of Acute Heart Failure	p. 205
Management of the Common Cardiac Causes of Hospitalization for Heart Failure	p. 208
Outcomes in Patients Hospitalized for Heart Failure	p. 209
Strategies to Reduce Admissions and Readmissions in Patients with Heart Failure	p. 210
References	p. 211
Models of Care and Disease Management Programmes	p. 215
Introduction	p. 215
Disease Management Programmes	p. 218
Disease Management Programmes: The Evidence	p. 227
Guidelines and Critical Care Pathways	p. 228
Remote and Rural Issues	p. 231
Telecardiology in Heart Failure	p. 232
Conclusions	p. 235
References	p. 235
Palliative and Supportive Care for Patients with Advanced and Terminal Heart Failure	p. 241
What is Palliative Care?	p. 242
Age-Related Problems and the Provision of Palliative Care	p. 243
Advanced and Terminal Heart Failure	p. 244
Management of Specific Symptoms	p. 248
Home and Hospital Care	p. 253
Withdrawal of Conventional Drugs	p. 254
The Palliative Care Needs of Heart Failure Patients	p. 254
Palliative Care Strategies for Heart Failure	p. 256
Timing the Introduction of Different Palliative Care Strategies	p. 256
Cardiological Issues	p. 259
The Management Implications of Advanced Heart Failure	p. 260
Control of Symptoms Using Mostly Generic Treatments	p. 261
Support in the Community: The Gold Standard Framework (GSF) and Advanced Care Planning (ACP)	p. 262
Terminal Heart Failure: Identifying the Dying Patient and Providing End-of-Life Care	p. 263
References	p. 265
Index	p. 271
Table of Contents provided by Ingram. All Rights Reserved.

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A Practical Guide to Heart Failure in Older People

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