© 2002 European Society of Cardiology
Heart failure in frail elderly patients: diagnostic difficulties, co-morbidities, polypharmacy and treatment dilemmas
a Ageing and Health, Department of Medicine, Ninewells Hospital and Medical School Dundee DD1 9SY, UK
b Department of Clinical Pharmacology and Therapeutics, Ninewells Hospital and Medical School Dundee DD1 9SY, UK
* Corresponding author. Tel.: +44-1382-632436; fax: +44-1382-660675. E-mail address: n.d.gillespie{at}dundee.ac.uk
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Abstract |
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Background: Heart failure (HF) is difficult to diagnose and treat in older patients. Symptoms may be non-specific and the presence of co-morbidities and polypharmacy complicate treatment strategies. There are, however, few data to quantify the extent of these problems in the very elderly.
Methods: A retrospective study of 116 patients (median age 86; range 65–98) with an established diagnosis of HF during their hospital admission. Main outcome measures: the accuracy of diagnosis of heart failure according to the European Society of Cardiology (ESC) definition. The aetiology and frequency of associated co-morbidities and the nature of drug treatment.
Results: The specificities of clinical signs, chest X-rays and abnormal ECGs for heart failure (ESC definition) were 50%, 20% and 9%, respectively. Only 28% of patients were admitted for worsening symptoms which could be attributed to HF. None of the patients had HF as their only medical problem. Co-morbidities included chest disease (30%), incontinence (29%), cerebrovascular disease (26%), musculoskeletal problems (41%). Barthel (activities of daily living) score was 
16/20 in 35%. Mental state questionnaire (MSQ) score was 7/10 in 38%. Ninety percent were taking four or more different medications. Thirty-nine percent were on psychotropic drugs. On discharge, a total of 88% of patients returned home to live independently and 35% were monitored by regular day hospital attendance.
Conclusion: Heart failure in frail elderly patients is often compounded by other major illnesses and polypharmacy which have a profound impact on their functional status. This has implications for the most effective targeting of evidence based treatment.
Key Words: Heart failure • Elderly • Co-morbidities • Polypharmacy • Day hospital
Received May 4, 2001; Revised July 26, 2001; Accepted September 19, 2001
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