Prevalence and underlying causes of dyspnoea in older people: a systematic review

Mourik, Yvonne van; Rutten, Frans H.; Moons, Karel G.M.; Bertens, Loes C. M.; Hoes, Arno W.; Reitsma, Johannes B.

doi:10.1093/ageing/afu001

Cited by 62 publications

(52 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Importantly, in the ARIC cohort, the prevalence of self-reported dyspnea did not change much (26% to 22%) after excluding participants with a previous history of cardiovascular (CHD, HF, stroke) or pulmonary (COPD, asthma) disease. Consistent with previous studies [2, 19, 20], we found several correlates of dyspnea such as age, gender and obesity. Together these only explained 8% of the variance in dyspnea self-report.…”

Section: Discussionsupporting

confidence: 92%

Prognostic Importance of Dyspnea for Cardiovascular Outcomes and Mortality in Persons without Prevalent Cardiopulmonary Disease: The Atherosclerosis Risk in Communities Study

et al. 2016

View full text Add to dashboard Cite

BackgroundThe relationship between dyspnea and incident heart failure (HF) and myocardial infarction (MI) among patients without previously diagnosed cardiopulmonary disease is unclear. We studied the prognostic relevance of self-reported dyspnea for cardiovascular outcomes and all-cause mortality in persons without previously diagnosed cardiopulmonary disease.Methods and ResultsWe studied 10 881 community-dwelling participants (mean age 57±6, 56% women, 25% black) who were free of prevalent cardiopulmonary disease from Atherosclerosis Risk in Communities Study. Dyspnea status at study entry using the modified Medical Research Council (mMRC) scale. The primary outcomes were time to HF, MI or all-cause death. Dyspnea prevalence was 22%, and was mild (mMRC grade 1 or 2) in 21% and moderate-to-severe (mMRC 3 or 4) in 1%. The main correlates of dyspnea were older age, female sex, higher BMI and active smoking. Over a follow-up of 19±5 years, greater self-reported dyspnea severity was associated with worse prognosis. Mild dyspnea was associated with significantly heightened risk of HF (adjusted Hazard Ratio, HR,1.30; 95% CI: 1.16–1.46), MI (adjusted HR 1.34; 95%CI: 1.20–1.50), and death (adjusted HR 1.16; 95%CI: 1.06–1.26), with moderate/severe dyspnea associated with an even greater risk (adjusted HR 2.14, 95%CI: 1.59–2.89; 1.93, 95%CI: 1.41–2.56; 1.96, 95%CI: 1.55–2.48, respectively).ConclusionIn community-dwelling persons free of previously diagnosed cardiopulmonary disease, self-reported dyspnea is common and, even when of mild intensity, it is independently associated with a greater risk of incident HF, MI, and death. Our data emphasize the prognostic importance of even mild self-reported dyspnea for cardiovascular outcomes.

show abstract

Section: Discussionsupporting

confidence: 92%

Prognostic Importance of Dyspnea for Cardiovascular Outcomes and Mortality in Persons without Prevalent Cardiopulmonary Disease: The Atherosclerosis Risk in Communities Study

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Dyspnea in older persons merits strong consideration as a public health concern. Across 20 study populations of older persons, for example, the prevalence of moderate to severe dyspnea ranged from 17% to 62%, with the highest rates in those aged 80 and older . Moderate to severe dyspnea occurs at low exertional workloads, corresponding to activities of daily living, and is associated with poor functional status and quality of life and high healthcare costs, hospitalization rates, and mortality …”

mentioning

confidence: 99%

Dyspnea in Community‐Dwelling Older Persons: A Multifactorial Geriatric Health Condition

Miner

Tinetti

Ness

et al. 2016

J American Geriatrics Society

View full text Add to dashboard Cite

Objectives The evaluation of dyspnea in older persons is traditionally focused on cardiorespiratory diseases, rather than systematically evaluating the multiple impairments that often occur with advancing age and which may also contribute to dyspnea. Accordingly, we have evaluated the associations between a broad array of cardiorespiratory and non-cardiorespiratory impairments and dyspnea in older persons. Design Cross-sectional. Setting Cardiovascular Health Study. Participants 4,413 community-dwelling persons; mean age was 72.6, 57.1% were female, 4.5% were African-American, 27.2% had less than a high school education, and 54.7% were ever-smokers. Measurements Dyspnea severity (American Thoracic Society grade ≥2 defined moderate-to-severe) and several impairments, including those established by: spirometry (forced expiratory volume in 1-second [FEV1]), maximal inspiratory pressure (respiratory muscle strength), echocardiography, ankle-brachial index, blood pressure, whole-body muscle mass (bioelectrical impedance), single chair stand (lower extremity function), grip strength, serum hemoglobin and creatinine, Center for Epidemiologic Studies Depression Scale (CES-D), Mini Mental State Examination, medication use, and body mass index (BMI). Results In a multivariable logistic regression model, impairments having strong associations with moderate-to-severe dyspnea included: FEV1

show abstract

“…Most studies were retrospective and included decompensated or hospitalised HF patients [8, 11, 12, 25–27]. Studies in stable chronic HF patients are, however, relatively scarce.…”

Section: Discussionmentioning

confidence: 99%

“…Not only do the two diseases share major symptoms such as dyspnoea and fatigue, they also have common etiological factors such as smoking and ageing [5–8]. Consequently, under- and over-diagnosing COPD in HF patients are common [9–12].…”

Section: Introductionmentioning

confidence: 99%

Impact of airflow limitation in chronic heart failure

et al. 2017

View full text Add to dashboard Cite

BackgroundComorbidities are common in chronic heart failure (HF) patients, but diagnoses are often not based on objective testing. Chronic obstructive pulmonary disease (COPD) is an important comorbidity and often neglected because of shared symptoms and risk factors. Precise prevalence and consequences are not well known. Therefore, we investigated prevalence, pulmonary treatment, symptoms and quality of life (QOL) of COPD in patients with chronic HF.Methods205 patients with stable HF for at least 1 month, aged above 50 years, were included from our outpatient cardiology clinic, irrespective of left ventricular ejection fraction. Patients performed post-bronchodilator spirometry, a six-minute walk test (6-MWT) and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). COPD was diagnosed according to GOLD criteria. Restrictive lung function was defined as FEV1/FVC ≥0.70 and FVC <80% of predicted value. The BODE and ADO index, risk scores in COPD patients, were calculated.ResultsAlmost 40% fulfilled the criteria of COPD and 7% had restrictive lung disease, the latter being excluded from further analysis. Noteworthy, 63% of the COPD patients were undiagnosed and 8% of those without COPD used inhalation therapy. Patients with COPD had more shortness of breath despite little difference in HF severity and similar other comorbidities. KCCQ was significantly worse in COPD patients. The ADO and BODE indices were significantly different.ConclusionCOPD is very common in unselected HF patients. It was often not diagnosed and many patients received treatment without being diagnosed with COPD. Presence of COPD worsens symptoms and negatively effects cardiac specific QOL.

show abstract

Prevalence and underlying causes of dyspnoea in older people: a systematic review

Abstract: dyspnoea is very common in older people, but estimates vary considerably between studies. Only one study describes the underlying causes.

Cited by 62 publications

References 31 publications

Prognostic Importance of Dyspnea for Cardiovascular Outcomes and Mortality in Persons without Prevalent Cardiopulmonary Disease: The Atherosclerosis Risk in Communities Study

Prognostic Importance of Dyspnea for Cardiovascular Outcomes and Mortality in Persons without Prevalent Cardiopulmonary Disease: The Atherosclerosis Risk in Communities Study

Dyspnea in Community‐Dwelling Older Persons: A Multifactorial Geriatric Health Condition

Impact of airflow limitation in chronic heart failure

Contact Info

Product

Resources

About