Heart failure in older people: causes, diagnosis and treatment.

Congestive heart failure affects >5% of those aged 65-75 and 10-20% of those aged >80 in the UK, and levels are likely to rise in the wake of improved therapies for hypertension and myocardial infarction. It is often multifactorial in this group. The most common causes are hypertension and coronary heart disease, with valvular heart disease playing an increasing role. The most common precipitant of pre-existing heart failure is non-compliance with medication or diet; non-steroidal anti-inflammatory drugs are particularly likely to exacerbate the condition. Diagnosis may be difficult since typical signs are often absent or masked in older people, but plasma levels of brain natriuretic peptide appear to be a reliable indicator and may provide diagnostic test in the future. Systolic heart failure is managed by conventional therapy (diuretics, angiotensin-converting enzyme inhibitors and beta-blockers). The management of diastolic heart failure is less well defined, but symptoms should be managed, ischaemia prevented and the underlying causes identified and treated. Nurse-directed, multidisciplinary intervention (including education of patient and family, social support, review of medication, dietary modification and weight monitoring) have resulted in improvements in event-free survival and quality of life.