Heart Failure in Elderly Patients

Pathophysiology
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HEART FAILURE IN ELDERLY PATIENTS
ABSTRACT
Heart failure has a high incidence rate among elderly patient in New Zealand. On the
epidemiology of heart failure in New Zealand, it is found that there are of 12,000 admissions
every year and it contributes to 33% of deaths every year. Prevalence of heart failure keeps on
increasing over every decade. On normal physiology of the cardiovascular system, the main
function of the cardiovascular system is to transmit materials throughout the body. Materials
entering the body such as oxygen from the lungs and nutrients and also water through intestinal
tract are carried to cells. Arteries carry blood away from the heart and veins return blood to the
heart. Pathophysiology of heart failure usually manifests through a decrease in the efficiency of
the heart muscle either through work overload or damage. The main symptom of heart failure is
increased heart rate and is usually stimulated by increased sympathetic activity such that
adequate cardiac output is maintained. Other symptoms include shortness of breath, chest pain,
pulses alternans, pulmonary edema, cough, loss of appetite, excess urination, dizziness and
fatigues. Diagnostic tests important for the diagnosis of heart failure are the x-ray image,
electrocardiogram, blood test, echocardiogram, stress test, magnetic resonance imaging, coronary
angiogram, and cardiac computerized tomography. Preventive measures of heart failure include
lifestyle changes, treatment of risk factors, education and creation of public awareness on heart
failure disease. On management, the pharmacologic management includes the use of drugs such
as vasodilators and diuretics while there is also the use of invasive therapies. On non-
pharmacologic ways of managing heart failure, there is dietary management, lifestyle changes,
daily regular activities, and stress management. Recommendations of this study are mainly on
management and treatment. It involves implementation of the management and treatment of
heart failure for example recommendation on dietary restriction of salt and fat in the diet.
INTRODUCTION
Elderly patients are a group of people who are not homogenous with wide or weaknesses and
fitness for each age. Age-related changes in the heart contribute to progressive loss of cardiac

cells, hypertrophy of the remaining cells and connective tissue accumulation which cause a
decline in diastolic function while systolic function with age. Heart disease is a very serious
problem in elderly patients which has caused high mortality and frequent hospitalization in
elderly patients (Lazzarini et.al, 2019), it is linked to deteriorating quality of life and aggressive
medical treatment which causes a lot of side effects for the elderly compared to younger people
because of differences in drug metabolism, drug interaction, wound healing, poor tolerance to
surgical procedures and impaired cognitive and psychosocial interaction leading to high
mortality rate for the elderly. Heart failure is a heart abnormality where the heart muscles are
unable to pump blood as well as it should be, it is also called congestive heart failure
(Ponikowski, et.al, 2014). It occurs as a result of narrowed arteries in the heart or too high blood
pressure that eventually leaves the heart too weak to be able to pump blood efficiently.
Incidences of congestive heart failure among elderly patient is increasing (Parén, et.al, 2014)
because they present with many complicated comorbidities for example hypertension, atrial
fibrillation, peripheral vascular disease, kidney failure, anemia and excess use of pharmaceutical
drugs which leads to many side effects, its management is hard because of the many of many
complications mentioned above. It is important to relate these conditions for proper management
of the condition. Its significance to New Zealand is that it is the major and gradually growing
problem that comes as are a result of its poor prognosis and it has an impact on health care is
costly placing a financial burden on the health care system. Non pharmacological strategies such
as dietary interventions for example restrictions of some diet intake such as potassium and
sodium-rich food, exercise training are important in reducing heart failure, functional and
cognitive assessment of this patients reduces risk of heart failure and it helps in guiding the
management in older heart failure patients and clinical trials that help in assessing the functional
status and quality of life and heart disease should be encouraged to help in guiding management
of this age group. A comprehensive assessment is important key action in the management of
patients of heart failure for early treatment of symptoms and monitoring of progress (O'Gara,
2013).
EPIDEMIOLOGY OF HEART FAILURE

Heart failure is becoming a global public health issue and is significantly increased over time. Its
diagnosis is majorly associated with low quality of life, poverty and high morbidity and mortality
rates despite management in the hospital. Overall, the number of heart failure patients aged ≥80
are more than a quarter of the community (Fowkes, 2013).
In New Zealand, it is estimated that every year there are about 12,000 hospital admissions of
nearly 5,500 patients heart failure. These patients stay in the hospital for an average length of 5
days. An average1.5-2% of the health budget is channeled towards Heart failure associated costs,
hence representing a notable burden in the healthcare system of New Zealand (Milne, 2012). The
Maori people have been found to get diagnosed with heart failure 10-15 years earlier than the
non-Maori individuals (Wang, 2013). It is estimated that the mortality from heart failure among
Maori males aged 45-64 years is eight times higher than the non-Maori. The Maori with age of
65 years and above also experience heart failure approximately 3 times higher than non-Maori.
Similar cases of high mortality rate are also seen in the Maori females, whereby, there is about 8
to 9 times more hospital admission among the compared than the non-Maori.
Further statistics have indicated that the number of people living with heart disease in New
Zealand is 186,000 which implies one in every 20 adults. Cardiovascular disease also is
responsible for 33% of deaths annually, which makes it the leading cause of death in New
Zealand. It includes; stroke, blood vessels, and stroke disease.
As the population ages, the prevalence of Heart failure keeps on increasing and over the next few
decades the number of people diagnosed with this condition will have gone up by 50%
NORMAL PHYSIOLOGY OF CARDIOVASCULAR SYSTEM
The following diagram illustrates the normal physiology of the cardiovascular system