Traitement de l'insuffisance cardiaque du sujet âgé

The treatment of heart failure is the subject of guidelines issued by scientific societies and organizations. It uses a combination of non-pharmacological management, including education and influenza and pneumococcal vaccinations, and pharmacological therapy. Pharmacological treatment of heart failure with systolic dysfunction is well codified. It must include an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) and a betablocker, sometimes in combination with a diuretic, digoxin or an aldosterone antagonist. Too often, the titration of ACE inhibitors and betablockers is insufficient and recommended dosages are not met even in the absence of contraindication. This illustrates the concept of underuse in the elderly. Regular reassessment of treatment is necessary to try to achieve the target doses of betablockers, ACE inhibitors or angiotensin receptor antagonists, while avoiding adverse effects of therapy. The treatment of heart failure with preserved systolic function is poorly codified in the absence of convincing results of the studies. It is based on the use of diuretics in case of decompensation and the active management of risk factors and etiological disease (hypertension).