Do all very old people have heart failure?

Question

A 95 year old will probably not be able to do hard exercise, such as running fast for one hour per day. The heart of such a person won't have the capacity to pump the required amount of blood through its body. However, most 95 year olds won't visit the doctor complaining about not being as fit as they where at the age of 25, any complaints about feeling tired, lack of energy etc. will typically be considered to be normal for the age.

But one can ask if in fact the aging of the heart is equivalent to having (mild) heart failure. Suppose that when I'm 95 years old I disguise myself, making myself look 25 years old. I then visit some doctor complaining about not being able to exercise at a reasonable intensity. If all sorts of tests are done, would I be diagnosed with heart failure? And would treatment for heart failure for healthy 95 year olds allow them to exercise at an intensity that is much higher than what could be considered to be normal for that age?

Answer 1

Maybe. Depends on the 95-year old... and the 25-year old. A heart failure diagnosis isn't just the process of getting older; it has objective criteria. I expect most 95-year olds would score above zero on this scale, many quite highly, but not all of them would.

And, of course, we know there are 25-year olds who would score highly too, so I'd say it's a race. Not a very fair one, but a race nonetheless.

http://www.aafp.org/afp/2000/0301/p1319.html

Boston Criteria for Diagnosing Heart Failure Criterion Point value*

Category I: history

• Rest dyspnea 4
• Orthopnea 4
• Paroxysmal nocturnal dyspnea 3
• Dyspnea while walking on level area 2
• Dyspnea while climbing 1

Category II: physical examination

• Heart rate abnormality (1 point if 91 to 110 beats per minute; 2 points if more than 110 beats per minute) 1 or 2
• Jugular venous elevation (2 points if greater than 6 cm H2O; 3 points if greater than 6 cm H2O plus hepatomegaly or edema) 2 or 3
• Lung crackles (1 point if basilar; 2 points if more than basilar) 1 or 2
• Wheezing 3
• Third heart sound 3

Category III: chest radiography

• Alveolar pulmonary edema 4
• Interstitial pulmonary edema 3
• Bilateral pleural effusion 3
• Cardiothoracic ratio greater than 0.50 3
• Upper zone flow redistribution 2

*— No more than 4 points are allowed from each of three categories; hence the composite score (the sum of the subtotal from each category) has a possible maximum of 12 points. The diagnosis of heart failure is classified as “definite” at a score of 8 to 12 points, “possible” at a score of 5 to 7 points, and “unlikely” at a score of 4 points or less.

Adapted with permission from Marantz PR, Tobin JN, Wassertheil-Smaller S, Steingart RM, Wexler JP, Budner N, et al. The relationship between left ventricular systolic function and congestive heart failure diagnosed by clinical criteria. Circulation 1988;77:607–12.

Answer 2

Can aging of the heart be equivalent to having (mild) heart failure?

Absolutely. A large part of aging is the process of telomeres shortening with each cell division, making our DNA more vulnerable. As more DNA damage accumulates, more cells in the heart (and everywhere else in the body) become dysfunctional - that's essentially what aging is.

So while aging doesn't necessarily directly contribute to heart-related problems, the probability of organ failure, or dysfunctional symptoms in the organ gets higher as we age, due to more and more cells failing to perform their function.

Here is a peer-reviewed paper on the subject (reading the abstract should be enough): http://www.ncbi.nlm.nih.gov/pubmed/20532978

Here is a study published in a UK medical journal linking DNA degradation due to aging with heart disease: https://www.newscientist.com/article/dn10942-shrinking-telomeres-linked-to-heart-disease/

Corrected some information, thanks FrankyG