Background: Little is known about the prevalence of heart failure among very old people, although hospitalisation rates for chronic heart failure are very high. Recently, brain natriuretic peptides have emerged as important diagnostic and prognostic serum markers for congestive heart failure. Aims: The main purpose of our study was to determine whether there is a cut-off for NT-proBNP for detecting the echocardiographic features of left ventricular systolic and/or diastolic dysfunction and clinical heart failure among old people living in nursing homes. Secondarily, we investigated the medium-term prognostic power of the neurohormone levels. Methods: We screened 101 old people (80% females, aged 84F9 years) from two nursing homes. We prospectively evaluated whether we could effectively stratify patients using a combination of (1) restrictive clinical criteria, (2) NT-proBNP measurements (Elecsys System, Roche Diagnostics) and (3) echocardiography for all patients. Results: Forty-two percent of the subjects had left ventricular dysfunction: 11% systolic, 23% diastolic and 8% both systolic and diastolic. The mean NT-proBNP concentration was 2806F7028 pg/ml in the 42 patients with left ventricular systolic and/or diastolic dysfunction, compared with 365F456 pg/ml in the 59 patients with normal left ventricular function ( pb0.01, Z=À4.8 Mann-Whitney U test). The neurohormone proved to be a good predictor of events within 6 months [area under the receiver-operated curve (ROC) = 0.79]. Conclusions: Blood NT-proBNP concentrations can play an important role in stratifying old people into left ventricular dysfunction risk groups. The neurohormone is an independent marker for death or admission for heart failure in the medium term.

Sebbene lo scompenso cardiaco rappresenti attualmente una delle malattie di maggiore rilevanza sociale, a causa della sua frequenza, morbilità, mortalità ed assorbimento di risorse, la sua prevalenza non è ancora nota con precisione. Si stima che esso interessi una quota ingente della popolazione generale, ma mancano dati precisi [1,2]. Per la popolazione italiana in particolare, tre studi hanno indagato la prevalenza nella popolazione generale, fornendo stime che variano da 7 a 20 casi per 1000 abitanti [3][4][5].Inoltre poco è noto sull'aderenza alle Linee Guida in materia nel "grosso" degli scompensati sul Territorio [6,7], mentre nulla è dato sapere sui costi sociali di malattia per lo scompenso cardiaco nel nostro Paese, i dati disponibili essendo limitati a stime approssimative, ottenute con approccio "top-down".È evidente tuttavia che l'identificazione dei pazienti affetti da scompenso cardiaco è mandatoria in considerazione della disponibilità di nuovi (betabloccanti [8-10] Heart failure is a preminent problem of public health, requiring innovating methods of health services organization. Nevertheless, data are still not available on prevalence, hospitalization rate, adherence to Guidelines and social costs in the general Italian population. The necessity to identifying patients with heart failure derives from the efficacy of new therapeutic interventions in reducing morbidity and mortality.In this study we aimed to identify, in a subset of the Eastern Veneto population, patients with heart failure through a pharmacologic-epidemiologic survey.The study was divided in 5 phases: 1) identification of patients on furosemide in the year 2000 in the ASL 10 of Eastern Veneto general population, through an analysis of a specific pharmaceutic service database; 2) definition of the actual prevalence of heart failure in a casual sample of these patients, through data base belonging to general practitioners, cardiologists, or others. Diagnosis was based on the following criteria: a) previous diagnosis of heart failure; b) previous hospitalization for heart failure; c) clinical evidence, with echocardiographic control in unclear cases; 3) survey of hospitalizations; 4) evaluation of adhesion to guidelines, through both databases and questionnaires; 5) analysis of the social costs of the disease, with a retrospective "bottom up" approach.From a total population of 198.000 subjects, we identyfied 4502 patients on furosemide. In a casual sample of 10.661 subjects we defined a prevalence of heart failure in Eastern Veneto of 1.1%, that rised to 7.1% in octuagenarians.The prescription of life saving drugs was satisfactory, while rather poor was the indication to echocardiography and to cardiologic consultation. Hospitalization rate for DRG 127 was low: 2.1/1000 inhabitants/year in the general polulation and 12.5 /1000 inhabitants/year in patients >70 years of age. Yearly mortality was 10.3%. Social costs were elevated (15.394 €/patient/year), due to a relevant sanitary component (hospital 53%, drugs 28%) and particularl...

No abstract

No abstract