Heart Failure

Heart failure (HF) remains a leading cause of morbidity and hospitalization in older adults. With the increased life expectancy and prevalent cardiovascular risk factors, the incidence of heart failure among older adults in post-acute and long-term care (PALTC) settings has risen. Recognizing, managing, and optimizing care for individuals with heart failure is pivotal, given the profound implications for functional status, quality of life, and overall prognosis.

For healthcare providers in PALTC settings, a comprehensive approach to heart failure encompasses:

• Accurate Diagnosis: This is often achieved through a combination of clinical history, physical examination, and diagnostic modalities such as echocardiography.
• Optimization of Pharmacotherapy: For heart failure with reduced ejection fraction (HFrEF), cornerstone treatments include angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and mineralocorticoid receptor antagonists (MRAs). Newer agents, such as sacubitril/valsartan, have shown promising results. The management of heart failure with preserved ejection fraction (HFpEF) remains challenging, with a focus on symptom relief and comorbidity management.
• Fluid Management: Diuretics play a pivotal role in symptom management, especially in the presence of pulmonary or peripheral edema. It is essential to strike a balance to prevent volume depletion and renal impairment.
• Comorbidity Management: Many older adults with heart failure also grapple with concomitant conditions like atrial fibrillation, ischemic heart disease, or renal dysfunction. A holistic approach, considering potential drug interactions and overlapping symptoms, is critical.
• Nutritional and Lifestyle Counseling: Sodium restriction, fluid monitoring, and weight tracking are integral components of heart failure management. Regular, person-centered, physical activity can aid in symptomatology and overall wellbeing.
• Monitoring and Prognostication: Frequent clinical evaluations, focusing on weight trends, symptom escalation, and potential drug side effects, are key. Given the potential for disease progression, advanced care planning and discussions regarding end-of-life care become crucial.
• Education and Self-Management: Empowering patients and caregivers with knowledge about heart failure, its manifestations, and management strategies, can significantly impact outcomes.