What’s new in caring for older adults with heart failure?

Sara Kalantari and pateint in wheelchair universal

Cardiologist and heart failure care team member Sara Kalantari, MD, cares for a patient in clinic.

As people age, their hearts sometimes don't function or pump blood as well as they should. Some people may be diagnosed with heart failure, a condition caused by a variety of things, including age, medications, a slowing metabolism and a changing lifestyle.

Advances in medicine – plus some exciting breakthrough treatments on the horizon – mean a heart failure diagnosis is no longer a death sentence. Can 80- or 90-year-olds live with heart failure? They can, and they do. In fact, I’ve helped heart failure patients as old as 103.

The Heart and Vascular Center care team at the University of Chicago Medicine uses a number of therapies to help restore vitality, relieve symptoms and help people live not just longer, but better lives.

What are the signs of heart failure in older adults?

People with heart failure typically feel an overwhelming sense of fatigue. They’ll find they may have shortness of breath while doing daily activities, like getting dressed, bathing or even putting on their shoes. Heart failure patients may also have swelling in their legs or abdomen that doesn’t improve, even with a normal dose of diuretic water pills. They also may need to prop themselves up with extra pillows to breathe more easily, which is a symptom of congestion because their body is filling up with fluids.

How do you treat advanced stage heart failure in older adults?

At UChicago Medicine, the cornerstone of our heart failure therapy is first-in-class medications that have been shown to improve and extend life. For more serious cases, we can provide heart transplants, ventricular assist devices (artificial heart pumps known as VADs) or a continuous infusion of inotropes, which are medicines that help the heart pump blood and can sustain people for many months or years. We also offer access to experimental therapies and drugs.

What new treatments are on the horizon?

I’m very excited about what the digital age will ultimately allow us to do with respect to new heart failure treatments. Soon we will have access to miniature devices that can be implanted into a person’s body without needing surgery. They’ll help a failing heart or kidney by reshaping the organ to help it function properly. There is also a lot of research on remote monitoring devices that can detect and prevent heart failure before it starts. The new technology will include very tiny implantable, ingestible or wearable devices that let doctors see in real time what a person’s heart pressures are. Artificial intelligence (AI) will interpret the collected data, which will give doctors a better picture of what’s happening than a one-time test in the doctor’s office. Then we’ll be able to help control heart problems remotely just by adjusting medications or giving individualized therapies. Where we’ll be in five to 10 years with this is really exciting. There are also medicines in the pipeline that will help increase survival for people with heart failure.

What are some ways to manage heart failure in older patients?

The best thing for older people with heart failure is to keep moving. Keep exercising. Pay attention to diet, and avoid high-sodium foods. Take your medicines. And create a dialogue with your healthcare providers. If something doesn’t feel right, they should talk to their physician and be good reporter, sharing as much information as possible so doctors can continue to provide the best treatment. They should stay hopeful and remain positive. This is a new age, and the treatments that we have for heart failure are better than they’ve ever been, and that extends to older patients as well.

How important is exercise and resistance training for seniors?

Things like exercise and strength training will help prevent heart failure. People can get in shape no matter how old they are. It’s a matter of going out there every day, and stretching so the muscles and joints are loose and flexible. No matter how old a person is, they can build muscle. That’s important, because after age 55, a person begins to lose muscle mass. So it’s important for older people to lift weights, exercise and keep their aerobic capacity up.

Can loneliness impact heart disease?

Yes. Loneliness can accelerate chronic illnesses and have a negative impact on the heart, and even lead to heart disease, which is a precursor to heart failure. Loneliness can lead people to not eat or take care of themselves. It’s also important to have companionship – for both emotional and safety reasons. To avoid isolation, older adults can use support groups to help them socialize. During COVID-19, they have to do this cautiously, with masks and social distancing, or via video. Connecting with others helps alleviate depression, sleep disturbances and feeling no pleasure in life.

Can taking too many medications impact older adults with heart failure?

Yes. As we age, the body doesn’t handle the medicine in the same way. It metabolizes medicines differently, which is why taking too many medications can be a problem for older patients with heart failure. As we age, the liver and kidneys don’t work as well, so drugs can sometimes build up in the system. Older people on medicines for their heart might be on five, six or 10 other drugs. So they’re taking a whole cocktail of medicines that might not work well together and could have side effects. It’s helpful to re-prioritize medications with your doctor. Over-the-counter pain medications can sometimes be very dangerous in older people because they can raise blood pressure and harm the kidneys. They can also have a sedative effect on people and cause delirium.

How well do heart transplants work?

Transplants are not always the best treatment for older patients, and the demand for donor hearts always outpaces supply. But we’re doing more heart transplants at UChicago Medicine, and I’m happy to see them saving more lives. We’re seeing big improvements in survival rates. The average survival rate is now over 11 years. Twenty years ago, the idea that someone could live 20 or 30 years with a transplanted heart was a fantasy. Not anymore.

Is heart disease irreversible for older adults?

As a clinical condition, yes, heart disease cannot be completely eliminated for patients of any age. However, we have treatments that can make it better. It’s a progressive illness, and it’s not something we can cure, but we can slow it down. It can progress so slowly so it doesn’t seem like it’s progressing at all.

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