Ungureanu G, Alexa Ioana Dana, Stoica Ortansa
Universitatea de Medicină si Farmacie Gr T Popa Iaşi Facultatea de Medicină, Disciplina de Medicină Internă.
Rev Med Chir Soc Med Nat Iasi. 2008 Apr-Jun;112(2):293-8.
The 21st century's demographic and epidemiologic perspectives suggest an absolute and percentual increment of elderly population. In the same time the prevalence of heart insufficiency increases with advanced age, which transforms heart failure in a true challenge for health insurance system. This new dimension of the problem resides in the increment of heart insufficiency's prevalence and in the high costs of medical care of these patients. Heart failure's medical costs are high not only due to the necessity of compensating the cardiac function but also due to the necessity of treating the etiology, the risk factors and the co-morbidities with cardiac side effects. Elderly patients usually have a low therapeutic compliance and an important number of iatrogenic reactions mainly due to poly-medication, poly-pathology and cognitive and physical deficiencies, which need special measures of therapeutic education for the patient and family and medical survey, probably best in a nursing house; all these elements increase significantly the cost, which is almost double than the cost for cancer. The prophylaxis in heart insufficiency means an extremely efficient management of entire cardiac pathology in order to delay the moment of heart failure. In elderly patients, the treatment in heart insufficiency is difficult not due to hospital treatment of decompensation episodes but due to low therapeutic compliance at home. We need special programs to ensure medical education of the patient and the family/caregiver in order to avoid iatrogenic pathology and to ensure therapeutic efficiency.
21世纪的人口统计学和流行病学观点表明，老年人口在绝对数量和百分比上都有所增加。与此同时，心力衰竭的患病率随着年龄的增长而上升，这使得心力衰竭成为医疗保险系统面临的一项真正挑战。这一问题的新层面在于心力衰竭患病率的增加以及这些患者高昂的医疗费用。心力衰竭的医疗成本高昂，不仅是因为需要补偿心脏功能，还因为需要治疗病因、风险因素以及伴有心脏副作用的合并症。老年患者通常治疗依从性较低，且存在大量医源性反应，主要是由于多种药物治疗、多种疾病以及认知和身体缺陷所致，这就需要针对患者及其家属采取特殊的治疗教育措施以及医疗监测，在养老院进行可能最为合适；所有这些因素都显著增加了成本，几乎是癌症治疗成本的两倍。心力衰竭的预防意味着对整个心脏疾病进行极其有效的管理，以推迟心力衰竭的发生。在老年患者中，心力衰竭的治疗困难不在于对失代偿发作进行住院治疗，而在于患者在家中的治疗依从性较低。我们需要特殊的项目来确保对患者及其家属/护理人员进行医学教育，以避免医源性疾病并确保治疗效果。
