A new clinical entity: multi-etiological heart failure in the elderly and its therapeutic implication

Heart failure (HF) is a major health problem for the geriatric population. In the United States, most of the 5 millions patients with HF are elderly.1 Seventy-five percent of HF hospitalizations occurred in patients older than 65 years and 50% in patients 75 years and older.1 In the Framingham population, the prevalence of HF increased eightfold among men from the fifth decade of life to the seventh decade.2 However, despite of considerable improvement in the treatment, the mortality of HF patients remained relatively constant between 1948 and 1997. Large epidemiologic surveys, such as the ongoing Framingham Study, have not documented any meaningful change in the HF patients' overall death rate. '-2-3 Between 1994 and 1997, in Ontario, approximately 33% of patients diagnosed with HF on the first admission died within 1 year.4-5 The mortality rate increased exponentially after age 65 in both men and women.4 Reduction in mortality demonstrated in randomized clinical trials of pharmacological agents, such as 3 -receptor blockers (BB) and angiotensin-converting enzyme inhibitors (ACEI), have been slow to be translated into substantial reductions of death and hospitalization rates in community-based HF populations.5 In more recent clinical trials, the addition of newer agents has had little, if any, impact on the high mortality of optimally treated patients.'-6 Accordingly, some authors have raised the concern that there may be limits to the benefits achievable through conventional pharmacological strategies.7-8 Therefore, there remains a need to develop novel, widely applicable, and cost-effective approaches in the management of HF.