Over 80% of all
heart failure patients are 65 years and older. The diagnosis and management of
heart failure in older adults can be challenging. However, with the correct clinical skill and experience, most geriatric
heart failure can be properly diagnosed and managed. Management of geriatric
heart failure can be simplified by following this useful mnemonic: DEFEAT
Heart Failure. This covers the essential aspects of geriatric
heart failure management: Diagnosis, Etiology, Fluid, Ejection fraAction, and Treatment. The process begins with a clinical Diagnosis, which must be established, before ordering an echocardiogram, as nearly half of all geriatric
heart failure patients have normal left ventricular ejection fraction. Because
heart failure is a syndrome and not a disease, an underlying Etiology must be sought and determined. Determination of the Fluid volume status by careful examination of the external jugular veins in the neck is vital to achieve euvolemia. An echocardiography should be ordered to obtain left ventricular Ejection frAction to assess prognosis and guide
Therapy. However, if left ventricular ejection fraction cannot be determined, as in many developing nations, all geriatric
heart failure patients should be treated as if they have low ejection fraction, and should be prescribed an
angiotensin-converting enzyme inhibitor and a beta-blocker.
Diuretic and
digoxin should be prescribed for all symptomatic patients with
heart failure. An
aldosterone antagonist may be used in select patients with advanced
systolic heart failure, carefully avoiding
hyperkalemia.