Service de gériatrie, hôpital Broca, AP-HP, 75013 Paris, France; EA 4468, gérontopôle d'Île-de-France, université de Paris, 75013 Paris, France.
Service de gériatrie, hôpital Charles-Foix, 94200 Ivry-sur-Seine, France; Faculté de médecine, Sorbonne université, 75103 Paris, France.
Arch Cardiovasc Dis. 2021 Mar;114(3):246-259. doi: 10.1016/j.acvd.2020.12.001. Epub 2021 Jan 14.
The prevalence of heart failure increases with age. In France, the 1-year mortality rate is 35% in subjects aged 80-89 years with heart failure, and 50% after the age of 90 years. In octogenarians, heart failure is associated with high rates of cardiovascular and non-cardiovascular events, and is one of the main causes of hospitalization and disability. The prevalence of frailty increases in elderly subjects with heart failure, and the co-occurrence of heart failure and frailty increases the risk of mortality in patients with heart failure. In the elderly, the presence of frailty must be evaluated using a comprehensive geriatric assessment to manage geriatric syndromes, such as cognitive disorders, malnutrition, falls, depression, polypharmacy, disability and social isolation. The objective of heart failure therapy in octogenarians is to reduce symptoms, mortality and hospitalizations, but also to improve quality of life. In the absence of specific studies involving very old subjects, most recommendations are extrapolated from evidence-based data from younger populations. Overall, the epidemiological studies in patients with heart failure aged>80 years highlight the underprescription of recommended drugs. This underprescription may be related to comorbidity, a fear of side-effects and the lack of specific recommendations for drug prescription in heart failure with preserved ejection fraction, which is common in this very old population. The benefit/risk ratio related to heart failure treatment and comorbidity should be carefully weighed and reassessed on a regular basis. Consideration of disease prognosis according to factors that predict mortality can help to better define the care plan and promote palliative and supportive care when needed.
心力衰竭的患病率随年龄增长而增加。在法国，80-89 岁心力衰竭患者的 1 年死亡率为 35%，90 岁以上患者的死亡率为 50%。在 80 岁以上的患者中，心力衰竭与心血管和非心血管事件的发生率较高有关，是导致住院和残疾的主要原因之一。心力衰竭老年患者衰弱的患病率增加，心力衰竭和衰弱同时存在会增加心力衰竭患者的死亡风险。在老年人中，必须使用全面的老年评估来评估衰弱的存在，以管理老年综合征，如认知障碍、营养不良、跌倒、抑郁、多种药物治疗、残疾和社会隔离。对 80 岁以上心力衰竭患者的治疗目标是减轻症状、降低死亡率和住院率，同时提高生活质量。由于缺乏涉及非常高龄患者的特定研究，大多数建议都是从年龄较轻的人群的基于证据的数据中推断出来的。总体而言，对年龄>80 岁的心力衰竭患者的流行病学研究强调了推荐药物的处方不足。这种处方不足可能与合并症、对副作用的恐惧以及心力衰竭伴射血分数保留患者药物处方缺乏具体建议有关，这种情况在这一非常高龄人群中很常见。应仔细权衡心力衰竭治疗和合并症的获益/风险比，并定期重新评估。根据预测死亡率的因素考虑疾病预后，可以帮助更好地确定护理计划，并在需要时促进姑息治疗和支持性护理。
