EVALUATION OF CONGESTIVE HEART FAILURE IN ELDERLY PATIENTS: MEDICATION APPROACH

Abstract

Introduction: Congestive heart failure (CHF) represents a significant health challenge in the elderly population, characterized by the inability of the heart to pump enough blood to meet the body's needs. In elderly patients, this condition often manifests atypically, with symptoms that can be easily confused with other common comorbidities in this age group, such as fatigue, dyspnea, and edema. The complexity of the clinical picture is exacerbated by the frequent presence of multiple comorbidities, physiological changes related to aging, and polypharmacy, which makes the therapeutic approach a delicate process that requires thorough assessment. Drug therapy for CHF in the elderly aims to alleviate symptoms, improve quality of life, reduce disease progression, and decrease mortality. However, the choice of drugs and their doses require caution, considering altered pharmacokinetics and pharmacodynamics, greater sensitivity to adverse effects, and potential drug interactions. Objective: The objective of this systematic literature review was to summarize the available scientific evidence on the pharmacological approach to congestive heart failure in elderly patients, identifying the main classes of drugs used, their benefits and specific risks in this population. Methodology: The methodology of this systematic review followed the PRISMA checklist guidelines. The search for relevant articles was performed in the PubMed, Scielo and Web of Science databases, using the following descriptors combined through Boolean operators: "heart failure", "elderly", "drug treatment", "pharmacotherapy" and "clinical studies". Articles published in the last 10 years were included. Inclusion criteria included clinical studies, systematic reviews and meta-analyses that evaluated the efficacy and safety of drugs used in the treatment of CHF in patients aged 60 years or older. Studies in animal models, isolated case reports and articles that did not specifically address drug therapy in the elderly population with CHF were excluded. Results: The results of the review showed that the main classes of medications used in the treatment of CHF in the elderly include angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), beta-blockers, diuretics, and mineralocorticoid receptor antagonists (MRAs). It was observed that the introduction and titration of these medications in the elderly often required a slower pace and lower doses due to the increased risk of hypotension and renal dysfunction. Studies have shown that the use of ACEIs/ARBs and beta-blockers was associated with reduced mortality and hospitalizations for CHF, while diuretics were important in controlling congestion symptoms. The addition of MRAs in selected patients also demonstrated prognostic benefits. However, polypharmacy and drug interactions represented significant challenges in the management of CHF in the elderly, demanding careful and individualized pharmacological assessment. Conclusion: The pharmacological approach to congestive heart failure in elderly patients is complex and multifaceted, requiring a comprehensive geriatric assessment that considers the physiological, clinical and pharmacological particularities of this population. The use of the main classes of drugs has been shown to be effective in improving clinical outcomes, but individualization of treatment, strict monitoring and prevention of drug interactions are crucial to optimize benefits and minimize risks in this age group.