STEMI and heart failure in the elderly: role of adverse remodeling

The elderly population (age ≥ 65 years) has been increasing worldwide. In North America and Europe, both heart failure (HF) and ST-segment elevation MI (STEMI) are more prevalent in the elderly. Morbidity, hospitalizations and costs associated with HF are higher in the elderly. Despite improved therapies, the bulk of cardiovascular deaths occur in the elderly. Survivors of acute STEMI develop progressive ventricular remodeling that leads to HF. There are several reasons for the increased HF burden in the elderly. First, there is a lack of clinical trial data exclusively in elderly patients for specific therapy of adverse remodeling post-STEMI and HF with low ejection fraction (HF/low-EF) or HF with preserved ejection fraction (HF/PEF). Second, there is the lack of data on the impact of aging on remodeling during healing post-STEMI and HF. Third, HF therapy in the elderly is more challenging because of aging-specific biological changes and associated comorbidities and polypharmacy. More research on aging and post-STEMI remodeling and clinical trials on post-STEMI remodeling and HF in the elderly are needed, especially in the “older-elderly” population segment aged ≥75 years.