Heart failure in frail elderly patients: diagnostic difficulties, co-morbidities, polypharmacy and treatment dilemmas

Eur J Heart Fail. 2002 Jan;4(1):91-8. doi: 10.1016/s1388-9842(01)00200-8.


Background: Heart failure (HF) is difficult to diagnose and treat in older patients. Symptoms may be non-specific and the presence of co-morbidities and polypharmacy complicate treatment strategies. There are, however, few data to quantify the extent of these problems in the very elderly.

Methods: A retrospective study of 116 patients (median age 86; range 65-98) with an established diagnosis of HF during their hospital admission.

Main outcome measures: the accuracy of diagnosis of heart failure according to the European Society of Cardiology (ESC) definition. The aetiology and frequency of associated co-morbidities and the nature of drug treatment.

Results: The specificities of clinical signs, chest X-rays and abnormal ECGs for heart failure (ESC definition) were 50%, 20% and 9%, respectively. Only 28% of patients were admitted for worsening symptoms which could be attributed to HF. None of the patients had HF as their only medical problem. Co-morbidities included chest disease (30%), incontinence (29%), cerebrovascular disease (26%), musculoskeletal problems (41%). Barthel (activities of daily living) score was < or = 16/20 in 35%. Mental state questionnaire (MSQ) score was < or =7/10 in 38%. Ninety percent were taking four or more different medications. Thirty-nine percent were on psychotropic drugs. On discharge, a total of 88% of patients returned home to live independently and 35% were monitored by regular day hospital attendance.

Conclusion: Heart failure in frail elderly patients is often compounded by other major illnesses and polypharmacy which have a profound impact on their functional status. This has implications for the most effective targeting of evidence based treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiotonic Agents / administration & dosage*
  • Cognition Disorders / epidemiology
  • Comorbidity
  • Drug Therapy, Combination
  • Female
  • Frail Elderly*
  • Heart Failure / diagnosis*
  • Heart Failure / drug therapy*
  • Heart Failure / epidemiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Hypothyroidism / epidemiology
  • Male
  • Musculoskeletal Diseases / epidemiology
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Stroke / epidemiology
  • Survival Rate


  • Cardiotonic Agents