La insuficiencia cardiaca es una de las principales causas de hospitalización y mortalidad en mayores de 70 años. Y, sin embargo, este grupo de pacientes a menudo no recibe los mismos tratamientos que el resto, ni son evaluados mediante herramientas que reflejen adecuadamente su complejidad clínica. La edad avanzada debe ser una llamada a actuar con mayor criterio y precisión: no se trata solo de edad, sino de contextos clínicos complejos donde la fragilidad, la multimorbilidad y el deterioro funcional o cognitivo son piezas clave que debemos integrar en la toma de decisiones.
¿Qué distingue la insuficiencia cardiaca en el paciente anciano? Pedro Caravaca repasa con David Chivite, Ainhoa Robles y Vicente Romero su fisiopatología, su evaluación integral y los desafíos que plantea su tratamiento individualizado.
Participantes:
Pedro Caravaca PérezCardiología. Hospital Clinic de Barcelona
David Chivite GuillénMedicina Interna. Servicio de Medicina Interna Hospital Universitari de Bellvitge, Barcelona
Ainhoa Robles MezcuaCardiología. Hospital Clínico Universitario Virgen de la Victoria, Málaga
Vicente Romero EstarlichGeriatría. Hospital General Universitario Gregorio Marañón, Madrid
- Epidemiology, pathophysiology, and prognosis of heart failure in older adults. Heart Fail Clin.2017;13(3):417-426. doi:10.1016/j.hfc.2017.02.001
- Frailty assessment in heart failure: an overview of the multi-domain approach. Curr Heart Fail Rep. 2018;15(1):17-23. doi:10.1007/s11897-018-0373-0
- State of the art in measuring frailty in patients with heart failure: from diagnosis to advanced heart failure. Curr Heart Fail Rep. 2025 Mar 8;22(1):11. doi: 10.1007/s11897-025-00699-9
- Heart failure in older patients: an update. J Clin Med. 2025;14(6):1982. doi:10.3390/jcm14061982
- Pathophysiology and management of heart failure in the elderly. Int J Angiol. 2022;31(4):251–9
- Heart failure with preserved ejection fraction in the elderly population: Basic mechanisms and clinical considerations. Can J Cardiol [Internet]. 2024;40(8):1424–44
- A systematic review and meta-analysis of frailty in patients with heart failure. J Eval Clin Pract. 2025;31(5):e14192
- Cardiogeriatrics: the current state of the art. Heart. 2024;110(14):933–9
- Interventions for frailty among older adults with cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol. 2022;79(5):482–503
- Deprescribing strategies in older patients with heart failure. Intern Emerg Med. 2025;20(2):599–609
- Deprescribing interventions for older patients: A systematic review and meta-analysis. J Am Med Dir Assoc. 2023;24(11):1718–25
- Epidemiological aspects, clinical management and short-term outcomes in elderly patients diagnosed with acute heart failure in the emergency department in Spain: results of the EDEN-34 study. Rev Clin Esp 2024;224:204-16
- High comorbidity, measured by the Charlson Comorbidity Index, associates with higher 1-year mortality risks in elderly patients experiencing a first acute heart failure hospitalization. Aging Clin Exp Res 2018;30:927–33
- Safety, tolerability and efficacy of up-titration of guideline directed medical therapies for acute heart failure in elderly patients: A sub-analysis of the STRONG-HF randomized clinical trial. Eur J Heart Fail 2023;25:1145-55
- Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE-HF cohort study. Eur J Heart Fail 2020;22:2112-9
- Basal functional status predicts one-year mortality after a heart failure hospitalization in elderly patients — The RICA prospective study. Int J Cardiol 2018;254:182-8
- Effect of b-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction. J Am Coll Cardiol 2021;78:2042–56
