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J Am Coll Cardiol. 2018 May 1;71(17):1921-1936. doi: 10.1016/j.jacc.2018.02.059.

Domain Management Approach to Heart Failure in the Geriatric Patient: Present and Future.

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Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address:
Division of Cardiology and Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York.
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan.
Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California.
Geriatrics Section, Veterans Affairs Portland Health Care System, Portland, Oregon; Department of Medicine, Oregon Health & Sciences University, Portland, Oregon.
Bon Secours Heart and Vascular Institute, Richmond, Virginia.
Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Cardiovascular Division, Department of Medicine, Department of Bioethics and Humanities, University of Washington Medical Center, Seattle, Washington.
Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.


Heart failure (HF) is a quintessential geriatric cardiovascular condition, with more than 50% of hospitalizations occurring in adults age 75 years or older. In older patients, HF is closely linked to processes inherent to aging, which include cellular and structural changes to the myocardium, vasculature, and skeletal muscle. In addition, HF cannot be considered in isolation of physical functioning, or without the social, psychological, and behavioral dimensions of illness. The role of frailty, depression, cognitive impairment, nutrition, and goals of care are each uniquely relevant to the implementation and success of medical therapy. In this paper, we discuss a model of caring for older adults with HF through a 4-domain framework that can address the unique multidimensional needs and vulnerabilities of this population. We believe that clinicians who embrace this approach can improve health outcomes for older adults with HF.


domain management; geriatric patient; heart failure

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