Treatment of heart failure with preserved ejection fraction.

Heart failure, in its diverse forms based on the value of the ejection fraction, is associated to high mortality and the frequent need for hospitalization, with a consequent heavy burden on healthcare resources. For an appropriate treatment of heart failure with preserved ejection fraction (HFpEF), there are no specific drugs effective for this condition. Those indicated in HF with reduced EF (HFrEF) are of more benefit in that form of HF, according to the guidelines of the European Society of Cardiology of 2016: ACE-inhibitors, beta-blockers, anti-aldosterones are all indicated with a class of recommendation/level of evidence IA; therapy with loop diuretics is indicated in the case of clinical congestion (IB). Studies carried out with ACE-inhibitor (or angiotensin-receptor antagonist) or beta-blocker or anti-aldosterone to evaluate their efficacy also in HFpEF have substantially shown a benefit only on a reduction in the hospitalization rate. The same guidelines identify regular aerobic activity (IA) as more effective in the condition of HFpEF and indicate, appropriately, the need to treat comorbidities (IC) in the elderly (where they are more present and more numerous). They also recommend to avoid certain associations of drugs and, obviously, harmful (and contraindicated) medications that could worsen the clinical picture or might be potentially lethal.

Safe and effective outcome of intravenous thrombolysis for acute ischemic stroke in patients aged 90 years or older.

Concerning intravenous thrombolysis, only inconclusive data are available for patients older than 90. We retrospectively evaluated 11 such patients whom we treated with thrombolysis from June 2007 through April 2012, comparing them to 41 patients of the same age whom we treated conventionally in the same period. Baseline clinical data were superimposable, except for shorter onset-to-hospital time for thrombolyzed patients. Mortality and hemorrhagic transformation did not differ. Functional status (modified Rankin scale) 3 months after was better in treated patients, even when compared to controls who arrived early in the hospital. Treated patients were more often discharged home or to intensive rehabilitation, less often to a nursing home. We conclude that safety and effectiveness of intravenous thrombolysis in eligible nonagenarians are evident in a setting of everyday practice, and that patients 90 years or older should not be denied thrombolysis solely on the basis of their age.