Heart failure in the elderly: strategies to optimize outpatient control and reduce hospitalizations.

Heart failure is a disorder that disproportionately affects the elderly, and over 50% of heart failure hospitalizations in the United States occur in persons over 75 years of age. Moreover, despite recent advances in heart failure therapy, optimal treatment of elderly patients remains undefined. In addition, heart failure management in older persons is often complicated by the presence of multiple comorbid conditions, polypharmacy, psychosocial and behavioral concerns, dietary issues, and economic considerations. As a result, management of heart failure in the elderly requires a coordinated, multidisciplinary approach, and a series of recent studies have documented the efficacy of heart failure disease management programs in reducing readmissions, enhancing medication and dietary compliance, and lowering cost of care. Ongoing studies will provide insights into the feasibility and effectiveness of implementing heart failure disease management programs on a population-wide basis, and on the effects of such programs on long-term clinical outcomes and costs.