Chris Ward and Miles Witham are the authors of A Practical Guide to Heart Failure in Older People, published by Wiley.

• Preface xiList of Contributors xiii1 Introduction 1Christopher Ward1.1 A Working Definition of Heart Failure 11.2 What do We Mean by ‘Older People?’ 21.3 The Expectations of Older Patients 41.4 Age-Related Problems in Heart Failure Treatment and Management 41.5 The Level of Evidence for Treating Older Patients 6References 72 Epidemiology 9Christopher Ward2.1 Epidemiology, Demography and Prognosis 92.2 Heart Failure with Preserved Left Ventricular Systolic Function (HF-PSF) 102.3 Prevalence, Incidence and Prognosis 112.4 Age and Prognosis 142.5 The Effects of Gender and Race on Prevalence and Prognosis 182.6 The Increasing Prevalence of Heart Failure and Longevity 192.7 The Implications of Epidemiological and Demographic Data 20References 223 Heart Failure and the Aging Heart 27Helen Oxenham3.1 Introduction 273.2 Overt and Subclinical Cardiovascular Disease in Older People 283.3 Age-Related Changes to Cardiac Structure and Function 333.4 Other Relevant Age-Related Changes 353.5 Responses of the Aging Cardiovascular System to Exercise, Normal Daily Activities and to Other Physiological Stresses 363.6 The Pathogenesis of Heart Failure 383.7 The Impact of Age-Related Changes to the Cardiovascular System on the Responses to Myocardial Damage 403.8 The Prevention of Heart Failure in Older People 40References 414 Aetiology 45Christopher Ward4.1 Classification of the Aetiologies of Heart Failure 454.2 The Importance of Identifying the Aetiology 474.3 Specific Aetiologies 484.4 Post-Myocardial Infarction (Post-MI) Heart Failure 494.5 Valvular Disease 514.6 The Cardiomyopathies 564.7 Atrial Fibrillation 57References 585 Diagnosis 63Christopher Ward5.1 Diagnostic Guidelines 645.2 Symptoms and Signs: Sensitivity and Specificity 655.3 Objective Evidence of Left Ventricular Systolic Dysfunction 665.4 Diagnostic Difficulties in Older Patients 705.5 Diagnosis, Patient Management and Clinical Profile 73References 766 Pharmacological Treatment 79Miles D. Witham6.1 Introduction 796.2 ACE Inhibitors 816.3 Beta-Blockers 836.4 Spironolactone 856.5 Diuretics 876.6 Digoxin 886.7 Hydralazine and Nitrates 896.8 Adding Angiotensin Receptor Blockers to ACE Inhibitors 906.9 Treating the Underlying Cardiovascular Disease 906.10 Medications to Avoid 906.11 Prescribing for Heart Failure with Preserved Systolic Function 926.12 Prescribing for Multiple Comorbidities 926.13 Prescribing at the End of Life 93References 937 Non-Pharmacological Management 97Sinéad P. McKee and Miles D. Witham7.1 Exercise Training 977.2 Types of Exercise Programme 987.3 Smoking 1007.4 Diet 1017.5 Alcohol 1037.6 Vaccinations 1047.7 Psychological Interventions 104References 1048 Comorbidity 107Andrew Elder8.1 Introduction 1078.2 The Prevalence of Comorbidities 1098.3 The Implications of Comorbidity 1098.4 Specific Comorbidities in Heart Failure 111References 1279 Treatment and Management in Primary Care 133Alan Begg9.1 Introduction 1349.2 The Role of Primary Care and the Patient Population 1349.3 Heart Failure Registers, Data Collection and Audit 1359.4 Heart Failure in General Practice 1409.5 Treatment and Management 1469.6 Specific Problems in Treating Older Patients 150References 15210 The Role of the Specialist Nurse 157Sinéad P. McKee10.1 Introduction 15710.2 The Role of the Specialist Nurse 15810.3 Clinic-Based versus Home-Based Service 16310.4 Multidisciplinary Team Liaison 16510.5 Specific Issues Affecting Older Patients 16610.6 End of Life Care 16910.7 Specialist Nurses and Education 169References 17111 The Role of the Heart Failure Specialist 175Maheshwar Pauriah, Aaron K.F. Wong and Chim C. Lang11.1 Introduction 17511.2 The Role of the Heart Failure Specialist 17611.3 The Provision of a Diagnostic Service and Patient Assessment 17711.4 Management of Patients with Acute or Worsening Heart Failure Symptoms 17811.5 Optimization of Heart Failure Treatment 18011.6 Treatment of Reversible Causes of Heart Failure 18411.7 Treatment of Concomitant Diseases 18711.8 Multidisciplinary Care 189References 19112 Hospitalization 197Andrew Hannah12.1 The Epidemiology of Hospitalization 19712.2 The Aetiology of Heart Failure in Hospitalized Patients 19812.3 Classification and Diagnosis of Acute Heart Failure (AHF) 19912.4 Causes and Precipitants of Hospitalization 20112.5 Treatment of Acute Heart Failure 20512.6 Management of the Common Cardiac Causes of Hospitalization for Heart Failure 20812.7 Outcomes in Patients Hospitalized for Heart Failure 20912.8 Strategies to Reduce Admissions and Readmissions in Patients with Heart Failure 210References 21113 Models of Care and Disease Management Programmes 215Martin Wilson and Stephen J. Leslie13.1 Introduction 21513.2 Disease Management Programmes 21813.3 Disease Management Programmes: The Evidence 22713.4 Guidelines and Critical Care Pathways 22813.5 Remote and Rural Issues 23113.6 Telecardiology in Heart Failure 23213.7 Conclusions 235References 23514 Palliative and Supportive Care for Patients with Advanced and Terminal Heart Failure 241Christopher Ward, Francis G. Dunn, Shona M.M. Jenkins and Martin Leiper14.1 What is Palliative Care? 24214.2 Age-Related Problems and the Provision of Palliative Care 24314.3 Advanced and Terminal Heart Failure 24414.4 Management of Specific Symptoms 24814.5 Home and Hospital Care 25314.6 Withdrawal of Conventional Drugs 25414.7 The Palliative Care Needs of Heart Failure Patients 25414.8 Palliative Care Strategies for Heart Failure 25614.9 Timing the Introduction of Different Palliative Care Strategies 25614.10 Cardiological Issues 25914.11 The Management Implications of Advanced Heart Failure 26014.12 Control of Symptoms Using Mostly Generic Treatments 26114.13 Support in the Community: The Gold Standard Framework (GSF) and Advanced Care Planning (ACP) 26214.14 Terminal Heart Failure: Identifying the Dying Patient and Providing End-of-Life Care 263References 265Index 271

Chris Ward and Miles Witham are the authors of A Practical Guide to Heart Failure in Older People, published by Wiley.

• Preface xiList of Contributors xiii1 Introduction 1Christopher Ward1.1 A Working Definition of Heart Failure 11.2 What do We Mean by ‘Older People?’ 21.3 The Expectations of Older Patients 41.4 Age-Related Problems in Heart Failure Treatment and Management 41.5 The Level of Evidence for Treating Older Patients 6References 72 Epidemiology 9Christopher Ward2.1 Epidemiology, Demography and Prognosis 92.2 Heart Failure with Preserved Left Ventricular Systolic Function (HF-PSF) 102.3 Prevalence, Incidence and Prognosis 112.4 Age and Prognosis 142.5 The Effects of Gender and Race on Prevalence and Prognosis 182.6 The Increasing Prevalence of Heart Failure and Longevity 192.7 The Implications of Epidemiological and Demographic Data 20References 223 Heart Failure and the Aging Heart 27Helen Oxenham3.1 Introduction 273.2 Overt and Subclinical Cardiovascular Disease in Older People 283.3 Age-Related Changes to Cardiac Structure and Function 333.4 Other Relevant Age-Related Changes 353.5 Responses of the Aging Cardiovascular System to Exercise, Normal Daily Activities and to Other Physiological Stresses 363.6 The Pathogenesis of Heart Failure 383.7 The Impact of Age-Related Changes to the Cardiovascular System on the Responses to Myocardial Damage 403.8 The Prevention of Heart Failure in Older People 40References 414 Aetiology 45Christopher Ward4.1 Classification of the Aetiologies of Heart Failure 454.2 The Importance of Identifying the Aetiology 474.3 Specific Aetiologies 484.4 Post-Myocardial Infarction (Post-MI) Heart Failure 494.5 Valvular Disease 514.6 The Cardiomyopathies 564.7 Atrial Fibrillation 57References 585 Diagnosis 63Christopher Ward5.1 Diagnostic Guidelines 645.2 Symptoms and Signs: Sensitivity and Specificity 655.3 Objective Evidence of Left Ventricular Systolic Dysfunction 665.4 Diagnostic Difficulties in Older Patients 705.5 Diagnosis, Patient Management and Clinical Profile 73References 766 Pharmacological Treatment 79Miles D. Witham6.1 Introduction 796.2 ACE Inhibitors 816.3 Beta-Blockers 836.4 Spironolactone 856.5 Diuretics 876.6 Digoxin 886.7 Hydralazine and Nitrates 896.8 Adding Angiotensin Receptor Blockers to ACE Inhibitors 906.9 Treating the Underlying Cardiovascular Disease 906.10 Medications to Avoid 906.11 Prescribing for Heart Failure with Preserved Systolic Function 926.12 Prescribing for Multiple Comorbidities 926.13 Prescribing at the End of Life 93References 937 Non-Pharmacological Management 97Sinéad P. McKee and Miles D. Witham7.1 Exercise Training 977.2 Types of Exercise Programme 987.3 Smoking 1007.4 Diet 1017.5 Alcohol 1037.6 Vaccinations 1047.7 Psychological Interventions 104References 1048 Comorbidity 107Andrew Elder8.1 Introduction 1078.2 The Prevalence of Comorbidities 1098.3 The Implications of Comorbidity 1098.4 Specific Comorbidities in Heart Failure 111References 1279 Treatment and Management in Primary Care 133Alan Begg9.1 Introduction 1349.2 The Role of Primary Care and the Patient Population 1349.3 Heart Failure Registers, Data Collection and Audit 1359.4 Heart Failure in General Practice 1409.5 Treatment and Management 1469.6 Specific Problems in Treating Older Patients 150References 15210 The Role of the Specialist Nurse 157Sinéad P. McKee10.1 Introduction 15710.2 The Role of the Specialist Nurse 15810.3 Clinic-Based versus Home-Based Service 16310.4 Multidisciplinary Team Liaison 16510.5 Specific Issues Affecting Older Patients 16610.6 End of Life Care 16910.7 Specialist Nurses and Education 169References 17111 The Role of the Heart Failure Specialist 175Maheshwar Pauriah, Aaron K.F. Wong and Chim C. Lang11.1 Introduction 17511.2 The Role of the Heart Failure Specialist 17611.3 The Provision of a Diagnostic Service and Patient Assessment 17711.4 Management of Patients with Acute or Worsening Heart Failure Symptoms 17811.5 Optimization of Heart Failure Treatment 18011.6 Treatment of Reversible Causes of Heart Failure 18411.7 Treatment of Concomitant Diseases 18711.8 Multidisciplinary Care 189References 19112 Hospitalization 197Andrew Hannah12.1 The Epidemiology of Hospitalization 19712.2 The Aetiology of Heart Failure in Hospitalized Patients 19812.3 Classification and Diagnosis of Acute Heart Failure (AHF) 19912.4 Causes and Precipitants of Hospitalization 20112.5 Treatment of Acute Heart Failure 20512.6 Management of the Common Cardiac Causes of Hospitalization for Heart Failure 20812.7 Outcomes in Patients Hospitalized for Heart Failure 20912.8 Strategies to Reduce Admissions and Readmissions in Patients with Heart Failure 210References 21113 Models of Care and Disease Management Programmes 215Martin Wilson and Stephen J. Leslie13.1 Introduction 21513.2 Disease Management Programmes 21813.3 Disease Management Programmes: The Evidence 22713.4 Guidelines and Critical Care Pathways 22813.5 Remote and Rural Issues 23113.6 Telecardiology in Heart Failure 23213.7 Conclusions 235References 23514 Palliative and Supportive Care for Patients with Advanced and Terminal Heart Failure 241Christopher Ward, Francis G. Dunn, Shona M.M. Jenkins and Martin Leiper14.1 What is Palliative Care? 24214.2 Age-Related Problems and the Provision of Palliative Care 24314.3 Advanced and Terminal Heart Failure 24414.4 Management of Specific Symptoms 24814.5 Home and Hospital Care 25314.6 Withdrawal of Conventional Drugs 25414.7 The Palliative Care Needs of Heart Failure Patients 25414.8 Palliative Care Strategies for Heart Failure 25614.9 Timing the Introduction of Different Palliative Care Strategies 25614.10 Cardiological Issues 25914.11 The Management Implications of Advanced Heart Failure 26014.12 Control of Symptoms Using Mostly Generic Treatments 26114.13 Support in the Community: The Gold Standard Framework (GSF) and Advanced Care Planning (ACP) 26214.14 Terminal Heart Failure: Identifying the Dying Patient and Providing End-of-Life Care 263References 265Index 271

Chris Ward and Miles Witham are the authors of A Practical Guide to Heart Failure in Older People, published by Wiley.

• Preface xiList of Contributors xiii1 Introduction 1Christopher Ward1.1 A Working Definition of Heart Failure 11.2 What do We Mean by ‘Older People?’ 21.3 The Expectations of Older Patients 41.4 Age-Related Problems in Heart Failure Treatment and Management 41.5 The Level of Evidence for Treating Older Patients 6References 72 Epidemiology 9Christopher Ward2.1 Epidemiology, Demography and Prognosis 92.2 Heart Failure with Preserved Left Ventricular Systolic Function (HF-PSF) 102.3 Prevalence, Incidence and Prognosis 112.4 Age and Prognosis 142.5 The Effects of Gender and Race on Prevalence and Prognosis 182.6 The Increasing Prevalence of Heart Failure and Longevity 192.7 The Implications of Epidemiological and Demographic Data 20References 223 Heart Failure and the Aging Heart 27Helen Oxenham3.1 Introduction 273.2 Overt and Subclinical Cardiovascular Disease in Older People 283.3 Age-Related Changes to Cardiac Structure and Function 333.4 Other Relevant Age-Related Changes 353.5 Responses of the Aging Cardiovascular System to Exercise, Normal Daily Activities and to Other Physiological Stresses 363.6 The Pathogenesis of Heart Failure 383.7 The Impact of Age-Related Changes to the Cardiovascular System on the Responses to Myocardial Damage 403.8 The Prevention of Heart Failure in Older People 40References 414 Aetiology 45Christopher Ward4.1 Classification of the Aetiologies of Heart Failure 454.2 The Importance of Identifying the Aetiology 474.3 Specific Aetiologies 484.4 Post-Myocardial Infarction (Post-MI) Heart Failure 494.5 Valvular Disease 514.6 The Cardiomyopathies 564.7 Atrial Fibrillation 57References 585 Diagnosis 63Christopher Ward5.1 Diagnostic Guidelines 645.2 Symptoms and Signs: Sensitivity and Specificity 655.3 Objective Evidence of Left Ventricular Systolic Dysfunction 665.4 Diagnostic Difficulties in Older Patients 705.5 Diagnosis, Patient Management and Clinical Profile 73References 766 Pharmacological Treatment 79Miles D. Witham6.1 Introduction 796.2 ACE Inhibitors 816.3 Beta-Blockers 836.4 Spironolactone 856.5 Diuretics 876.6 Digoxin 886.7 Hydralazine and Nitrates 896.8 Adding Angiotensin Receptor Blockers to ACE Inhibitors 906.9 Treating the Underlying Cardiovascular Disease 906.10 Medications to Avoid 906.11 Prescribing for Heart Failure with Preserved Systolic Function 926.12 Prescribing for Multiple Comorbidities 926.13 Prescribing at the End of Life 93References 937 Non-Pharmacological Management 97Sinéad P. McKee and Miles D. Witham7.1 Exercise Training 977.2 Types of Exercise Programme 987.3 Smoking 1007.4 Diet 1017.5 Alcohol 1037.6 Vaccinations 1047.7 Psychological Interventions 104References 1048 Comorbidity 107Andrew Elder8.1 Introduction 1078.2 The Prevalence of Comorbidities 1098.3 The Implications of Comorbidity 1098.4 Specific Comorbidities in Heart Failure 111References 1279 Treatment and Management in Primary Care 133Alan Begg9.1 Introduction 1349.2 The Role of Primary Care and the Patient Population 1349.3 Heart Failure Registers, Data Collection and Audit 1359.4 Heart Failure in General Practice 1409.5 Treatment and Management 1469.6 Specific Problems in Treating Older Patients 150References 15210 The Role of the Specialist Nurse 157Sinéad P. McKee10.1 Introduction 15710.2 The Role of the Specialist Nurse 15810.3 Clinic-Based versus Home-Based Service 16310.4 Multidisciplinary Team Liaison 16510.5 Specific Issues Affecting Older Patients 16610.6 End of Life Care 16910.7 Specialist Nurses and Education 169References 17111 The Role of the Heart Failure Specialist 175Maheshwar Pauriah, Aaron K.F. Wong and Chim C. Lang11.1 Introduction 17511.2 The Role of the Heart Failure Specialist 17611.3 The Provision of a Diagnostic Service and Patient Assessment 17711.4 Management of Patients with Acute or Worsening Heart Failure Symptoms 17811.5 Optimization of Heart Failure Treatment 18011.6 Treatment of Reversible Causes of Heart Failure 18411.7 Treatment of Concomitant Diseases 18711.8 Multidisciplinary Care 189References 19112 Hospitalization 197Andrew Hannah12.1 The Epidemiology of Hospitalization 19712.2 The Aetiology of Heart Failure in Hospitalized Patients 19812.3 Classification and Diagnosis of Acute Heart Failure (AHF) 19912.4 Causes and Precipitants of Hospitalization 20112.5 Treatment of Acute Heart Failure 20512.6 Management of the Common Cardiac Causes of Hospitalization for Heart Failure 20812.7 Outcomes in Patients Hospitalized for Heart Failure 20912.8 Strategies to Reduce Admissions and Readmissions in Patients with Heart Failure 210References 21113 Models of Care and Disease Management Programmes 215Martin Wilson and Stephen J. Leslie13.1 Introduction 21513.2 Disease Management Programmes 21813.3 Disease Management Programmes: The Evidence 22713.4 Guidelines and Critical Care Pathways 22813.5 Remote and Rural Issues 23113.6 Telecardiology in Heart Failure 23213.7 Conclusions 235References 23514 Palliative and Supportive Care for Patients with Advanced and Terminal Heart Failure 241Christopher Ward, Francis G. Dunn, Shona M.M. Jenkins and Martin Leiper14.1 What is Palliative Care? 24214.2 Age-Related Problems and the Provision of Palliative Care 24314.3 Advanced and Terminal Heart Failure 24414.4 Management of Specific Symptoms 24814.5 Home and Hospital Care 25314.6 Withdrawal of Conventional Drugs 25414.7 The Palliative Care Needs of Heart Failure Patients 25414.8 Palliative Care Strategies for Heart Failure 25614.9 Timing the Introduction of Different Palliative Care Strategies 25614.10 Cardiological Issues 25914.11 The Management Implications of Advanced Heart Failure 26014.12 Control of Symptoms Using Mostly Generic Treatments 26114.13 Support in the Community: The Gold Standard Framework (GSF) and Advanced Care Planning (ACP) 26214.14 Terminal Heart Failure: Identifying the Dying Patient and Providing End-of-Life Care 263References 265Index 271