Acute decompensated heart failure: Decision pathways for older people

Introduction: Acute decompensated heart failure (ADHF) is a common condition in older people, but little research has been conducted on the appropriate decision pathways for this population. The aim of this review was to explore ADHF management in older people, paying particular attention to the comprehensive geriatric assessment (CGA). Material and methods: A search was run in the PubMed literature database, combining the term "acute heart failure" with "management", "geriatric" "multidisciplinary", "co-management", "co-care", "approach", and "comprehensive geriatric assessment", from the databases inception to 1st January 2015. A manual check was also conducted on the reference lists in the articles and reviews identified as relevant to check for any additional sources of information. Results: The management of older patients with ADHF depends on the setting. After being assessed at the emergency department, unstable patients could be addressed to intensive care or coronary care units, while the in-hospital solutions for stable patients could be an observation unit or a cardiology or internal medicine ward. For end-stage patients, the hospital at home with telemonitoring and the hospice are worthwhile options. In all these settings, a CGA could improve the management of patients with ADHF. Conclusions: The most appropriate pathway for elderly ADHF patient management depends on several factors, including hemodynamic stability, social and family networks. CGA seems to be relevant because it enables a global assessment of this complex patient. Future trials are needed, however, to test whether a multidimensional approach to these patients could reduce their mortality rate and other negative outcomes. © 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society.