Are Elderly Patients with Suspected HF Misdiagnosed?

Olofsson, Mona; Edebro, Dan; Boman, Kurt

doi:10.1159/000095422

Cited by 29 publications

(28 citation statements)

References 45 publications

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“…In some studies, dyspnoea, the most common symptom at presentation, was present in both sexes to the same extent. 51 In our own investigation, women referred for transplantation were more frequently in NYHA class III-IV, had lower exercise tolerance, worse pulmonary function, and poorer kidney function than men, despite similar age or EF. They also had a lower prevalence of AF.…”

Section: Clinical Aspectsmentioning

confidence: 69%

Sex and Gender Differences in Myocardial Hypertrophy and Heart Failure

Regitz‐Zagrosek

Oertelt‐Prigione

Seeland

et al. 2010

Circ J

166

103

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EpidemiologyHeart failure (HF) is one of the leading hospital discharge diagnoses in the modern world and has enormous implications with respect to cardiovascular mortality and morbidity, to individual quality of life experiences and societal resource utilization. The number of patients with HF is continuously increasing. Approximately 10% of 70-year-olds are affected, with an increasing prevalence after that age. HF patients have a life expectancy of approximately 5 years, similar to patients with malignant disease. Women with HF are older than their male counterparts and more likely to exhibit a non-ischemic cause of the disease. 1 The population-based Framingham study suggests that the prognosis in women is significantly better than in men after the onset of HF. 2 However, despite the higher mortality in men, given the overall longer lifespan of women, total numbers of HF deaths are higher in women. The incidence of HF increases dramatically in the female population over 55 years, further compensating the sex differences in mortality. This also appears to account for the stronger correlation between age and mortality observed in women. In fact, in men the NYHA class at baseline is the strongest predictor of mortality, whereas in women it is age. African-Americans might have a higher incidence of HF than Caucasians, with men affected more frequently than females.Major risk factors in both sexes are: age, presence of diabetes, anemia, elevated blood pressure, presence of AF, myocardial hypertrophy (MH) and prior myocardial infarction. Distribution of risk factors differs between the sexes. Women more frequently exhibit hypertension 1,3 and diabetes mellitus. 1,3 Hypertension contributes to the population attributable risk for HF in women to a greater extent than in men. 4 Obesity, diabetes, and impaired glucose carry a greater risk in women and inhibit or impair myocardial metabolism more severely in women than in men. 5-7 Men are more likely to suffer from preexisting coronary heart disease 1,8 and dilated cardiomyopathy (DCM). In the Euro HF survey, systolic HF was found predominantly in men whereas women presented with HF with preserved ejection fraction (EF) or diastolic HF. 9-11 Both systolic and diastolic HF carry a poor prognosis, with astonishingly small differences. 12 MH is a major risk factor for HF and is a negative prognostic sign in itself. Interestingly, women are better protected against the development of MH than men. However, even though MH appears later in women than it does in men at a given hemodynamic load, once established, it is more malign in women. 13 Left ventricular (LV) mass has been presented as the strongest independent mortality predictor in females. Sex and Gender Differences in Myocardial Hypertrophyand Heart Failure Vera Regitz-Zagrosek, MD; Sabine Oertelt-Prigione, MD; Ute Seeland, MD; Roland Hetzer, MDHeart failure (HF) is a leading cause of cardiovascular mortality and morbidity in the Western world. It affects men at younger age than women. Women have more frequently diast...

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Section: Clinical Aspectsmentioning

confidence: 69%

Sex and Gender Differences in Myocardial Hypertrophy and Heart Failure

Regitz‐Zagrosek

Oertelt‐Prigione

Seeland

et al. 2010

Circ J

166

103

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“…Of those invited to the study up to 67% were men and in the group of participants the proportion of men was even higher, 78%. We could have expected a higher proportion of women in this population as CHF is as or more common among women in this age group (Olofsson et al., ) than in men.…”

Section: Discussionmentioning

confidence: 90%

A mixed methods study of Tai Chi exercise for patients with chronic heart failure aged 70 years and older

2018

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Aims and objectivesThis study aimed to evaluate Tai Chi group training among patients with chronic heart failure (CHF) aged 70 years and older.BackgroundPhysical activity is recommended for CHF treatment. Tai Chi is found to be beneficial to different patient groups, although few studies focus on older patients with CHF.DesignA mixed methods study. Participants were randomly assigned to Tai Chi training twice a week for 16 weeks (N = 25) or control (N = 20). Quantitative data were collected at baseline, at the end of the training period and 6 months after training, assessing self‐rated fatigue and quality of life, natriuretic peptides and physical performance. Individual qualitative interviews were conducted with participants (N = 10) in the Tai Chi training group.ResultsNo statistical differences between the Tai Chi training group and the control group in quality of life or natriuretic peptides was found. After 16 weeks, the training group tended to rate more reduced activity and the control group rated more mental fatigue. Participants in the training group rated increased general fatigue at follow‐up compared with baseline. Qualitative interviews showed that Tai Chi training was experienced as a new, feasible and meaningful activity. The importance of the leader and the group was emphasized. Improvements in balance were mentioned and there was no physical discomfort.ConclusionTai Chi was experienced as a feasible and meaningful form of physical exercise for patients with CHF aged over 70 years despite lack of achieved health improvement. Further investigations, using feasibility and meaningfulness as outcome variables seems to be useful.

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“…Of a population of 40 participants from a previous study population (3,4,12), 22 were considered for inclusion in this study, since 18 had died. Of these 22, eight were excluded for various reasons: dementia (n = 3); serious cognitive disorders communicated by relatives (n = 3); living in residential care home (n = 2); and four declined to participate.…”

Section: Participantsmentioning

confidence: 99%