Chronic heart failure (CHF) is a progressive condition that is associated with an enormous hospitalization burden and a poor quality of life (Azad & Lemay, 2014). The disease is a problem of the aged because more than a half of all CHF patients are older than 75 years (Azad & Lemay, 2014). The burden of CHF is expected to increase over the next decade, which necessitates the development of optimal prognostic pathways. The aim of this paper is to discuss CHF while focusing on common signs and symptoms, screening assessment tools, diagnostic tests, and treatment plans.
Discussion
Elderly patients with CHF often present with edema, fatigue, and dyspnea. The diagnosis of the condition is made when signs and symptoms of congestion along with reduced tissue perfusion are documented in the presence of abnormal systolic or diastolic cardiac function (McKelvie et al., 2013). However, it can be difficult to make a definite diagnosis of the condition due to the fact that its manifestations are neither sensitive nor specific (McKelvie et al., 2013). Therefore, it is important to consider atypical presentations especially in the case of obese patients. Such presentations can come in the form of fatigue, loss of appetite, and falls among others.
When the initial diagnosis is uncertain, it is recommended to measure natriuretic peptides (NPs). A screening assessment tool that features NPs as a predictor has been developed by Baggish and associates (McKelvie et al., 2013). According to guidelines on the management of heart failure issued by the American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) task force, coronary angiography should also be used for patients with angina (Yancy et al., 2013). Azad and Lemay (2014) argue that measurements of CBC, electrolytes, TSH, CXR, and ECG are needed for patients with CHF. Other recommendations for diagnosis of CHF are 12-lead ECG, echocardiography, coronary angiography, and the NYHA classification (severity of symptoms) (McKelvie et al., 2013).
When it comes to the treatment of the condition, the key goals are the alleviation of symptoms and hospitalization prevention. Pharmacologic management of CHF presupposes the use of diuretics, which necessitates the control of renal function. Digoxin is used for rate control; however, it can cause toxicity in elderly female patients (Azad & Lemay, 2014). Angiotensin receptor blocker (APB) therapy can be used at a low dose. It should be noted that small increases in serum creatinine (30 percent) do not necessitate immediate discontinuation of the therapy (McKelvie et al., 2013). There are also benefits in using spironolactone for treatment of the condition. Patients with normal renal function can be prescribed low doses of aldosterone antagonists; however, serum potassium monitoring should be conducted at regular intervals (McKelvie et al., 2013). Beta-blockers are also effectively used for the management of the condition.
A non-pharmacologic treatment plan presupposes the development of self-management skills as well as medication and diet adherence. Furthermore, the patients should be encouraged to exercise regularly. There is ample evidence that the use of an implantable cardiac defibrillator (ICD) can reduce morbidity by 23 percent (McKelvie et al., 2013). Cardiac resynchronization and tele-home monitoring should also be considered.
Conclusion
The paper has discussed CHF as the major cause of hospitalization for elderly patients. It has been argued that a definite diagnose of the disease is complicated by the fact that its clinical presentations are not specific. Moreover, older patients are more likely to have atypical presentations such as fatigue and loss of appetite.
References
Azad, N., & Lemay, G. (2014). Management of chronic heart failure in the older population. Journal of Geriatric Cardiology, 11(4), 329-337.
McKelvie, R., Moe, G. W., Ezekowitz, J. A., Heckman, G. A., Costigan, J., Ducharme, A.,… Sussex, B. (2013). The 2012 Canadian Cardiovascular Society heart management guidelines update: Focus on acute and chronic heart failure. Canadian Journal of Cardiology, 29(2), 168-181.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H.,… Wilkoff, B. (2013). 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 62(16), 147-239.