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Heart failure: definitions, investigation, and management 

Heart failure: definitions, investigation, and management
Heart failure: definitions, investigation, and management
Oxford Textbook of Geriatric Medicine (3 edn)

John G. F. Cleland

and John Baxter


Heart failure is among the most common chronic debilitating conditions among older adults. The diagnosis is complex and usually made late, only after severe symptoms develop. Natriuretic peptides (BNP or NT-proBNP) are the key to early diagnosis of heart failure and echocardiography to its cause; most commonly ventricular dysfunction [either with a reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction] or valve disease. For patients with HFrEF, pharmacological treatment with angiotensin converting-enzyme (ACE) inhibitors and mineralo-corticoid receptor antagonists and for those in sinus rhythm beta-blockers and ivabradine have transformed prognosis. For patients with a QRS duration >140 msec, cardiac resynchronization with atrio-biventricular pacing should be considered. Iron deficiency should be sought for and treated. For patients with HFpEF, robust evidence that treatments improve outcome is lacking but for symptoms, the pharmacological treatment of HFpEF and HFrEF may be rather similar.

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