期刊名称：Journal of Patient-Centered Research and Reviews
电子版ISSN：2330-0698
出版年度：2016
卷号：3
期号：4
页码：199-206
出版社：Aurora Health Care
摘要：The aging human population has emerged as a critically important factor in health care, not only due to the unique physiologic and pathologic processes associated with aging but also because of the evolution of medical and surgical therapies that have increased quality and quantity of life. Heart failure is a disease found most commonly among older populations in whom it is associated with high morbidity and mortality. Heart failure disproportionately affects the elderly, and it stands to reason that the most terminal stage, known as advanced heart failure (AHF), is more common among the elderly. Despite limited data, treatment options for AHF patients, including heart transplantation and left ventricular assist device (LVAD) therapy, have demonstrated improved quality and quantity of life. Similarly, a well-structured palliative care program may offer symptom relief and social support without the need for high-risk surgical options. Furthermore, as the therapeutic window (risk/benefit ratio) is narrower among elderly patients, the potential for positive outcomes from AHF options must be carefully evaluated together with patient-specific risks in the context of palliative care discussions. Therefore, the decision to leverage these options must be balanced with not only age, but also frailty, comorbidities, and cognition, functional, social and nutritional status to determine the right candidates for each therapy. This review strives to inform providers on the relevant considerations when leveraging AHF options among elderly patients. We conclude by providing a personalized model for care developed at a large tertiary care hospital that has performed more than 1,600 AHF procedures (870 heart transplants, 745 LVADs).
