Domain Management Approach to Heart Failure in the Geriatric Patient Present and Future

• Type of Material: Article
• Authors: Eiran Z. Gorodeski, Cleveland Clinic; Parag Goyal, Weill Cornell Medical College; Scott L. Hummel, University of Michigan; Ashok Krishnaswami, Kaiser Permanente San Jose Medical Center; Sarah J. Goodlin, Oregon Health and Science University; Linda L. Hart, Bon Secours Heart & Vascular Institute; Daniel E. Forman, University of Pittsburgh; Nanette Wenger, Emory University; James N. Kirkpatrick, University of Washington; Karen P. Alexander, Duke University
• Language: English
• Date: 2018-05-01
• Publisher: Elsevier Science Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 by the American College of Cardiology Foundation. Published by Elsevier.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacc.2018.02.059
• Title of Journal or Parent Work: Journal of the American College of Cardiology
• Volume: 71
• Issue: 17
• Start Page: 1921
• End Page: 1936
• Grant/Funding Information: None declared
• Keywords: Depressive symptoms; Cardiovascular System & Cardiology; Cardiovascular disease; domain management; heart failure; Quality of life; Social insulation; geriatric patient; Ejection fraction; All-cause mortality; Cognitive impairment; Older adults; Cardiac & Cardiovascular Systems; Science & Technology; Life Sciences & Biomedicine; 2013 ACCF/AHA guideline; Ventricular assist device
• Research Categories: Health Sciences, Medicine and Surgery; Gerontology; Health Sciences, Pathology; Health Sciences, Health Care Management

Abstract

Heart failure (HF) is a quintessential geriatric cardiovascular condition, with more than 50% of hospitalizations occurring in adults age 75 years or older. In older patients, HF is closely linked to processes inherent to aging, which include cellular and structural changes to the myocardium, vasculature, and skeletal muscle. In addition, HF cannot be considered in isolation of physical functioning, or without the social, psychological, and behavioral dimensions of illness. The role of frailty, depression, cognitive impairment, nutrition, and goals of care are each uniquely relevant to the implementation and success of medical therapy. In this paper, we discuss a model of caring for older adults with HF through a 4-domain framework that can address the unique multidimensional needs and vulnerabilities of this population. We believe that clinicians who embrace this approach can improve health outcomes for older adults with HF.