CHF in the elderly: When atypical presentations and concomitant illness complicate therapy

Several factors make the diagnosis and management of CHF in elderly patients particularly challenging. These include the increased incidence of co-morbid conditions and physical handicaps (impaired hearing, vision, dexterity, or cognitive ability) that necessitate use of multiple drugs and that hinder compliance. Also, the presenting signs may be atypical in older persons (somnolence, confusion, disorientation, weakness, and fatigue). Diuretics remain a mainstay of therapy. ACE inhibitors can decrease symptoms and hospital admissions and improve exercise performance and survival; thus, they are strongly indicated in symptomatic heart disease. Reserve digoxin for instances when symptoms persist despite ACE inhibitor therapy and a flexible diuretic program. The role of angiotensin Il inhibitors is under investigation. β-Blockers have shown great promise in the treatment of heart failure, but their clinical use is still being investigated.