M W Rich

..Given the relative paucity of data in the very elderly, additional studies are needed to define optimal pharmacologic and nonpharmacologic treatment of acute MI in this rapidly growing, high-risk population...

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..In light of these factors, this article reviews the epidemiology, pathophysiology, clinical features, and treatment of heart failure in older adults...

..This article reviews the effects of common noncardiac comorbidities on the management of HF in older adults and discusses the impact of noncardiac comorbid conditions on clinical outcomes in the geriatric HF patient...

..These findings indicate that thrombolytic therapy is beneficial in carefully selected elderly patients with acute myocardial infarction and that the risk of major adverse events is acceptably low...

..Although heart failure in the elderly differs in many important respects from heart failure occurring in middle-aged patients, the general approach to diagnosis and management is similar in younger and older patients...

..In conclusion, pooled data from 2 large randomized trials indicate that the efficacy of ranolazine is similar in older and younger patients but that adverse effects are more common in the elderly...

..This article summarizes these recommendations as they apply to older adults and highlights factors that may modulate the diagnosis and treatment of VTED in the elderly patient...

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..Future research must therefore be directed at developing more effective strategies for the prevention of heart failure in our aging population...

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..This article reports the prevalence of depression in a larger sample of hospitalized patients with CHF and identifies demographic, medical, psychosocial, and methodological factors that may affect prevalence estimates...

..Obstructive sleep apnea/hypopnea syndrome (OSAHS) is frequently comorbid with depression and is also a risk factor for cardiac events. Undetected OSAHS could help explain the increased risk associated with depression...

..Cardiac autonomic nervous system (ANS) dysregulation, proinflammatory processes, and procoagulant processes have been suggested as possible explanations...

..These data suggest that in patients 80 years and older who are hospitalized with acute myocardial infarction, an invasive strategy confers a significant survival advantage during the first year after hospital discharge...

..Patients at high risk for falls are presumed to be at increased risk for intracranial hemorrhage, and high risk for falls is cited as a contraindication to antithrombotic therapy. Data substantiating this concern are lacking...

..A simple summation score may help clinicians predict outcomes in symptomatic geriatric patients beyond standard clinical variables...

..Our objective was to find a bleeding classification scheme that could quantify the risk of hemorrhage in elderly patients with atrial fibrillation...

..Further research is needed to clarify the relationships among depression, heart failure, and adverse outcomes, as well as to develop efficacious interventions for depressive disorders in patients with heart failure...

..Novel HRV Predicts CV Mortality in the Elderly...

..Orientation to heart failure, particularly as a disease of aging, can help critically refine management of acute and chronic disease, as well as foster preventive strategies to reduce incidence of this common malady...

..For these reasons, it is essential to develop more effective strategies for the prevention and treatment of AF in older individuals...

..Low intake of omega-3 FAs is associated with depression and with low HRV, and all three are associated with an increased risk of death in patients with CHD...

..Anemia is an independent predictor of mortality and morbidity for numerous cardiovascular and noncardiovascular diseases, but the association of anemia with mortality and hospitalizations in patients with AF requires clarification...

..Studies of depressed psychiatric patients have shown that antidepressant efficacy can be increased by augmentation with omega-3 fatty acids...

..Further evaluation of this treatment strategy, including an assessment of the cost-effectiveness, is warranted...

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..We review the pathophysiology, clinical features, and management of iron-deficiency-induced cardiomyopathy...

..Traditional predictors of mortality in patients with reduced LVEF may not apply to elderly patients with preserved LVEF...

..Multidisciplinary strategies for the management of heart failure and end-of-life care are also briefly discussed...

..Patients who have atrial fibrillation (AF) have an increased risk of stroke, but their absolute rate of stroke depends on age and comorbid conditions...

..To identify predictors of 6-month mortality in older patients with heart failure (HF) and to develop a risk score for identifying potential candidates for hospice care...

..As the population ages, it is anticipated that the number of older people with HF will increase dramatically over the next several decades...

..To evaluate outcomes following cardiac surgery in nonagenarians...

..A simple 7-item risk score, based on data readily available at the time of admission, provides a reliable estimate of prognosis...

..The implication of these data is that many falls may be preventable through permanent pacemaker implantation in appropriately selected patients...

..These arrhythmias are clinically significant, and are a marker for increased mortality and prolonged hospital stay. Additional studies are needed to identify high-risk patients who may benefit from prophylactic anti-arrhythmic therapy...

..We sought to characterize age-specific practices and outcomes among patients with heart failure undergoing device implantation using a large nationally representative administrative database...

..This article describes each of these challenges in turn...

..The authors conclude that anemia is not an important predictor of long-term survival in very elderly patients hospitalized with HF...

..Outpatient care accounts for a significant proportion of total heart failure (HF) expenditures. This observation, plus an expanding list of treatment options, has led to the development of the disease-specific HF clinic...

..To determine the effects of digoxin on all-cause mortality and heart failure (HF) hospitalizations, regardless of ejection fraction, accounting for serum digoxin concentration (SDC)...

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..Whether treatment for HF contributes to WRF is unknown. In this study, we sought to assess whether acute treatment for patients who were hospitalized with HF contributes to WRF...

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..Reasons include limited trial data to guide the care of older adults and uncertainty about benefits and risks, particularly with newer medications or invasive treatments and in the setting of advanced age or complex health status...

..Although digoxin was tested in an appreciable number of diastolic heart failure patients in the Digitalis Investigation Group ancillary trial, detailed findings from this important study have not previously been published...

..Such patients often have multiple coexisting geriatric syndromes that may affect management and outcomes and are frequently underdiagnosed and untreated...

..Patients with diastolic HF should be evaluated for CKD, and the role of inhibitors of the renin-angiotensin system in these patients needs to be investigated...

..As in patients with systolic HF, those with diastolic HF should be routinely evaluated for myocardial ischemia and managed accordingly...

..This suggests that therapeutic interventions which improve renal function might be beneficial...

..The relationship of changes in weight to outcomes in patients after myocardial infarction (MI) is controversial...

..The goal of this study was to determine the prevalence of worsening renal function (WRF) among hospitalized heart failure (HF) patients, clinical predictors of WRF, and hospital outcomes associated with WRF...

..Reforms that might improve the effectiveness of the linkages between research, policy, and practice are suggested...

..BNP levels correlate clinical and physiologic characteristics, as well as outcomes. We sought to investigate the influence of BNP pathway genetic variation on BNP levels after adjustment for clinical/physiologic factors...

..This case demonstrates that systemic mastocytosis can present as recurrent syncope and even as cardiac arrest. Diagnosis of this rare but potentially fatal disease is made particularly challenging by its protean manifestations...

..In symptomatic patients who fail pharmacologic therapy, invasive strategies such as AV nodal ablation may help improve quality of life and symptoms, although such strategies do not obviate the need for antithrombotic therapy...

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