心力衰竭的患病率随着年龄的增长而增加。在法国,80-89岁心力衰竭患者的1年死亡率为35%,90岁后的50%。在八十岁的时候,心力衰竭与心血管事件和非心血管事件的高发率相关,是住院和致残的主要原因之一。老年心力衰竭患者虚弱的患病率增加,心力衰竭和虚弱的同时发生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虚弱的存在,以管理老年综合征,比如认知障碍,营养不良,falls,抑郁症,多药,残疾和社会隔离。八十岁老人心力衰竭治疗的目的是减轻症状,死亡率和住院,也是为了提高生活质量。在缺乏涉及非常古老的受试者的具体研究的情况下,大多数建议是从年轻人群的循证数据中推断出来的.总的来说,对年龄>80岁心力衰竭患者的流行病学研究突出了推荐药物的处方不足.这种不良处方可能与合并症有关,对副作用的恐惧和缺乏对保留射血分数的心力衰竭的药物处方的具体建议,这在这个老年人群中很常见。与心力衰竭治疗和合并症相关的获益/风险比应仔细权衡并定期重新评估。根据预测死亡率的因素考虑疾病预后有助于更好地定义护理计划,并在需要时促进姑息性和支持性护理。
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.