The Present and Future
Council Perspectives
Domain Management Approach to Heart Failure in the Geriatric Patient: Present and Future

https://doi.org/10.1016/j.jacc.2018.02.059Get rights and content
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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.

Key Words

domain management
geriatric patient
heart failure

Abbreviations and Acronyms

HF
heart failure
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
LVAD
left ventricular assist device
MNA
The Mini Nutritional Assessment
PHQ
Patient Health Questionnaire

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The views expressed in this paper by the American College of Cardiology's (ACC's) Geriatric Cardiology Member Section Council do not necessarily reflect the views of the Journal of the American College of Cardiology or the ACC.

Dr. Gorodeski is supported by The Hunnell Fund. Dr. Goyal is supported by National Institute on Aging grant R03AG056446. Dr. Hummel has received research funding from PurFoods, LLC. Dr. Hart has served on the Speakers Bureau of Zoll and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.

Drs. Gorodeski and Goyal contributed equally to this work and are joint first authors.