Review article
State of the science for care of older adults with heart disease

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Changes in the aging cardiovascular system

As people age, changes occur in the cardiovascular system that can affect cardiac structure, function, and ability to respond to physiologic and pathologic stressors (Box 1). The process of normal aging varies greatly among individuals, however, and knowledge is still evolving as data from longitudinal studies become available [4]. The most important changes are reduced responsiveness to beta-adrenergic stimulation, increased stiffness of the heart and vasculature, and altered myocardial energy

Coronary heart disease

Rates of CHD increase as people age, and most (57.9%) people discharged from hospital with primary diagnoses of CHD are over the age of 65 [9], [10]. Older persons with CHD are challenging, because most (52%) have two or more comorbid conditions that may complicate treatment [11]. A higher proportion of adults aged 70 or older with CHD are likely to report poor overall health (49%) and disability (49%) than younger adults aged 51 to 61 with CHD (32% and 43%, respectively) [12].

Although data are

Heart failure

Treatments for CHD have improved significantly over the past few decades, and now people with CHD typically survive MI and live to develop, a clinical syndrome resulting from a primary abnormality in the function of the heart as a pump [118]. HF results from complex interactions among molecular, neuroendocrine, and biodynamic systems, with cardiovascular remodeling (structural changes occurring within the heart) being a central feature in its progression [119]. Cardiac and noncardiac factors

Summary

This article provided an overview of the current state of knowledge related to cardiovascular disease in elders. Some depth has been provided related to CHD and HF, two common diagnoses in older persons. The most striking finding is that although trials are increasingly including older cohorts of patients, research specifically testing known therapies in older patients is essential. In particular, research testing the safety, efficacy, and acceptability of therapies in the oldest old is greatly

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