Heart failure is effectively a disease of older people. Eighty percent of patients are over 65 years old, and the majority of these are over 75. This figure is likely to increase significantly in the next two decades. The prognosis is worse than that of most cancers and heart failure is the commonest reason for hospital admission in the over 65s. The problems associated with treating heart failure in older patients are more diverse and complex than in those who are younger. The diagnosis in older patients is easily overlooked and as they were excluded from most heart failure treatment trials there has been a reluctance to treat them optimally (fewer than 20 are prescribed conventional medicines). They have multiple co-morbidities which are poorly managed, they are repeatedly hospitalised, and suffer social isolation. These important age-related treatment and management problems have been largely ignored and this book aims to redress the balance. It provides 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.
A Practical Guide to Heart Failure in Older People is essential reading for geriatricians, cardiologists, general hospital physicians, family practitioners and specialist nurses. * Specifically addresses the particular needs of the elderly, a largely ignored group who constitute the majority of patients with heart failure * Presents a concise yet comprehensive account of the evidence relating to the diagnosis, treatment and management of heart failure in this population * Improves awareness of the various roles within the management team
Contents Chapter 1 Introduction Christopher Ward 1.1 A Working Definition of Heart Failure 1.2 What do We Mean by 'Older People?' 1.3 The Expectations of Older Patients 1.4 Age-Related Problems in Heart Failure Treatment and Management 1.5 The Level of Evidence for Treating Older Patients References Chapter 2 Epidemiology Christopher Ward 2.1 Epidemiology, Demography and Prognosis 2.2 Heart Failure with Preserved Left Ventricular Systolic Function 2.3 Prevalence, Incidence and Prognosis 2.4 Age and Prognosis 2.5 The Effects of Gender and Race on Prevalence and Prognosis 2.6 The Increasing Prevalence of Heart Failure and Longevity 2.7 The Implications of Epidemiological and Demographic Data References Chapter 3 Heart Failure and the Aging Heart Helen Oxenham 3.1 Introduction 3.2 Overt and Subclinical Cardiovascular Disease in Older People 3.3 Mitral Annular Calcification 3.4 Age-Related Changes to Cardiac Structure and Function 3.5 Other Relevant Age-Related Changes 3.6 Responses of the Aging Cardiovascular System to Exercise, Normal Daily Activities and to Other Physiological Stresses 3.7 he Pathogenesis of Heart Failure 3.8 The Impact of Age-Related Changes to the Cardiovascular System on the Responses to Myocardial Damage 3.9 The Prevention of Heart Failure in Older People References Chapter 4 Aetiology Christopher Ward 4.1 Classification of the Aetiologies of Heart Failure 4.2 The Importance of Identifying the Aetiology 4.3 Specific Aetiologies 4.4 Post-Myocardial Infarction Heart Failure 4.5 Valvular Disease 4.6 The Cardiomyopathies 4.7 Atrial Fibrillation References Chapter 5 Diagnosis Christopher Ward 5.1 Diagnostic Guidelines 5.2 Symptoms and Signs: Sensitivity and Specificity 5.3 Objective Evidence of Left Ventricular Systolic Dysfunction 5.4 Diagnostic Difficulties in Older Patients 5.5 Diagnosis, Patient Management and Clinical Profile References Chapter 6 Pharmacological Treatment Miles D. Witham 6.1 Introduction 6.2 ACE Inhibitors 6.3 Beta-Blockers 6.4 Spironolactone 6.5 Diuretics 6.6 Digoxin 6.7 Hydralazine and Nitrates 6.8 Adding Angiotensin Receptor Blockers to ACE Inhibitors 6.9 Treating the Underlying Cardiovascular Disease 6.10 Medications to Avoid 6.11 Prescribing for Heart Failure with Preserved Systolic Function 6.12 Prescribing for Multiple Comorbidities 6.13 Prescribing at the End of Life References Chapter 7 Non-Pharmacological Management Sinead P. McKee and Miles D. Witham 7.1 Exercise Training 7.2 Types of Exercise Programme 7.3 Smoking 7.4 Diet 7.5 Alcohol 7.6 Vaccinations 7.7 Psychological Interventions References Chapter 8 Comorbidity Andrew Elder 8.1 Introduction 8.2 The Prevalence of Comorbidities 8.3 The Implications of Comorbidity 8.4 Specific Comorbidities in Heart Failure References Chapter 9 Treatment and Management in Primary Care Alan Begg 9.1 Introduction 9.2 The Role of Primary Care and the Patient Population 9.3 Heart Failure Registers, Data Collection and Audit 9.4 Heart Failure in General Practice 9.5 Treatment and Management 9.6 Specific Problems in Treating Older Patients References Chapter 10 The Role of the Specialist Nurse Sinead P. McKee 10.1 Introduction 10.2 The Role of the Specialist Nurse 10.3 Clinic-Based versus Home-Based Service 10.4 Multidisciplinary Team Liaison 10.5 Specific Issues Affecting Older Patients 10.6 End of Life Care 10.7 Specialist Nurses and Education References Chapter 11 The Role of the Heart Failure Specialist Maheshwar Pauriah, Aaron K.F. Wong and Chim C. Lang 11.1 Introduction 11.2 The Role of the Heart Failure Specialist 11.3 The Provision of a Diagnostic Service and Patient Assessment 11.4 Management of Patients with Acute or Worsening Heart Failure Symptoms 11.5 Optimization of Heart Failure Treatment 11.6 Treatment of Reversible Causes of Heart Failure 11.7 Treatment of Concomitant Diseases 11.8 Multidisciplinary Care References Chapter 12 Hospitalization Andrew Hannah 12.1 The Epidemiology of Hospitalization 12.2 The Aetiology of Heart Failure in Hospitalized Patients 12.3 Classification and Diagnosis of Acute Heart Failure 12.4 Causes and Precipitants of Hospitalization 12.5 Treatment of Acute Heart Failure 12.6 Management of the Common Cardiac Causes of Hospitalization for Heart Failure 12.7 Outcomes in Patients Hospitalized for Heart Failure 12.8 Strategies to Reduce Admissions and Readmissions in Patients with Heart Failure References Chapter 13 Models of Care and Disease Management Programmes Martin Wilson and Stephen J. Leslie 13.1 Introduction 13.2 Disease Management Programmes 13.3 Disease Management Programmes: The Evidence 13.4 Guidelines and Critical Care Pathways 13.5 Remote and Rural Issues 13.6 Telecardiology in Heart Failure 13.7 Conclusions References Chapter 14 Palliative and Supportive care for Patients with Advanced and Terminal Heart Failure Christopher Ward, Francis G. Dunn, Shona M.M. Jenkins and Martin Leiper 14.1 What is Palliative Care? 14.2 Age-Related Problems and the Provision of Palliative Care 14.3 Advanced and Terminal Heart Failure 14.4 Management of Specific Symptoms 14.5 Home and Hospital Care 14.6 Withdrawal of Conventional Drugs 14.7 The Palliative Care Needs of Heart Failure Patients 14.8 Palliative Care Strategies for Heart Failure 14.9 Timing the Introduction of Different Palliative Care Strategies 14.10 Cardiological Issues 14.11 The Management Implications of Advanced Heart Failure 14.12 Control of Symptoms Using Mostly Generic Treatments 14.13 Support in the Community: The Gold Standard Framework and Advanced Care Planning 14.14 Terminal Heart Failure: Identifying the Dying Patient and Providing End-of-Life Care References
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