Evolution of a Geriatric Syndrome: Pathophysiology and Treatment of Heart Failure with Preserved Ejection Fraction
Bharathi Upadhya, Barbara Pisani, Dalane W Kitzman, Bharathi Upadhya, Barbara Pisani, Dalane W Kitzman
Abstract
The majority of older adults who develop heart failure (HF), particularly older women, have a preserved left ventricular ejection fraction (HFpEF). The prevalence of this syndrome is increasing, and the prognosis is not improving, unlike that of HF with reduced ejection fraction (HFrEF). Individuals with HFpEF have severe symptoms of effort intolerance, poor quality of life, frequent hospitalizations, and greater likelihood of death. Despite the importance of HFpEF, there are numerous major gaps in our understanding of its pathophysiology and management. Although it was originally viewed as a disorder due solely to abnormalities in left ventricular diastolic function, our understanding has evolved such that HFpEF is now understood as a systemic syndrome involving multiple organ systems, and it is likely that it is triggered by inflammation and other as-yet-unidentified circulating factors, with important contributions of aging and multiple comorbidities, features generally typical of other geriatric syndromes. We present an update on the pathophysiology, diagnosis, management, and future directions in this disorder in older persons.
Keywords: aging; comorbidities; elderly; heart failure; preserved ejection fraction.
Conflict of interest statement
Potential Financial Conflicts of Interest:
Dr. Kitzman declares the following relationships: Consultant for: Abbvie; Bayer; Merck; Medtronic; St. Luke’s Medical Center, Kansas City, MO; GSK; Relypsa; Corvia Medical; Boehringer-Ingelheim; and Actavis; research grant funding from Novartis; and stock ownership in Gilead Sciences.
Dr. Upadhya has received research funding from Novarits and Corvia.
© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.
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Source: PubMed