Acute heart failure syndromes in the elderly

In the United States, persons 75 years of age or older comprise just 6.2% of the general population, yet they account for well over half of all emergency department visits for acute decompensated heart failure (ADHF),1 and the median age of patients enrolled in the Acute Decompensated Heart Failure National Registry (ADHERE) is 75.3 years.2 Moreover, these patients differ substantially from patients typically enrolled in HF clinical trials; not only are they older, but they are more likely to be women, more likely to have preserved left ventricular (LV) ejection fraction, more likely to have hypertension rather than coronary artery disease as the primary etiology, and more likely to have multiple coexisting medical conditions (especially renal insufficiency) that complicate management.3 Furthermore, hospital mortality rates for ADHF are higher by a factor of three among patients 75 years of age or older compared to patients younger than age 75.4