Treatment of chronic heart failure in the elderly. Status of the art

Treatment of chronic heart failure (CHF) is strongly focused on evidence-based medicine. However, large trials are often far away from the "real world" of geriatric patients and their messages are poorly transferable to the clinical management of CHF elderly patients. Precipitating factors and especially non-cardiac comorbility may decompensate CHF in the elderly. More importantly, drugs of first choice, such as Angiotensin Converting Enzyme inhibitors and beta-blockers, are still underused and effective drugs on diastolic dysfunction are not available. Poor adherence to therapy, especially due to cognitive disorders and depression, worsens the management. Electrical therapy is indicated, but attention to the older age groups with reduced life expectancy has to be paid. Physical exercise, stem cells, gene therapy and new devices are encouraging, but definitive results are not available yet. Palliative care plays a key role in the end-stage of the disease. Follow-up of CHF elderly patient is very important but tele-medicine is the future. Finally, self-care management, caregiver training and multidimensional team represent the critical point of the treatment of CHF elderly patients.