Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion

Abstract

Aims The majority of patients with heart failure are diagnosed in primary care, but underdiagnosis is common. Shortness of breath is a prevalent complaint of older persons and one of the key symptoms of heart failure. We assessed the prevalence of unrecognized heart failure in elderly patients presenting to primary care with shortness of breath on exertion. Methods and results This was a cross‐sectional selective screening study. Patients aged 65 years or over presenting to primary care with shortness of breath on exertion in the previous 12 months were eligible when not known to have an established, echocardiographic confirmed diagnosis of heart failure. All participants underwent history taking, physical examination, electrocardiography, and a blood test of N‐terminal pro B‐type natriuretic peptide (NTproBNP). Only those with an abnormal electrocardiogram or NTproBNP level exceeding the exclusionary cut‐point for non‐acute onset heart failure (>15 pmol/L (≈125 pg/mL) underwent open‐access echocardiography. An expert panel established presence or absence of heart failure according to the criteria of the European Society of Cardiology heart failure guidelines. The mean age of the 585 participants was 74.1 (SD 6.3) years, and 54.5% were female. In total, 92 (15.7%, 95% CI 12.9–19.0) participants had heart failure: 17 (2.9%, 95% CI 1.8–4.7) had heart failure with a reduced ejection fraction (≤45%), 70 (12.0%, 95% CI 9.5–14.9) had heart failure with preserved ejection fraction, and five (0.9%, 95% CI 0.3–2.1) had isolated right‐sided heart failure. Conclusion Elderly primary care patients with shortness of breath on exertion often have unrecognized heart failure, mainly with preserved ejection fraction.

Epidemiology and Prognosis of Heart Failure

“…Indeed, its prevalence rises with age, increasing sharply from 1% in 40-yearold individuals, affecting about 10% of men and 8% of women aged more than 60 years, and exceeding 10% in both sexes over the age of 70 years [9]. Indeed, among elderly people (≥65 years) referred to primary care services for shortness of breath on exertion, 1 out of 6 presents with previously unrecognised heart failure, mainly heart failure with preserved ejection fraction (HFpEF) [10,11]. Also, more than 80% of the deaths and prevalent cases of heart failure occur among people aged ≥65 years [1].…”

“…In a recent European retrospective cohort study [15], based on admissions in 2012, only 17% of heart failure patients had HFpEF type whilst the 83% were diagnosed with HFrEF. However, there is inconsistency across studies for the prevalence rates of HFpEF, generally ranging from 22% to 73% [25][26][27][28][29][30][31][32]24,11]. Such variability probably depends on the definition of HFpEF (e.g.…”

Clinical Diagnosis In Heart Failure

“…[7] Signs such as an audible third heart sound (S3), displacement of the apical impulse and elevated jugular venous pressure are specific for heart failure, but their identification is more difficult [4] and reproducibility is poor. [5,13] Also signs of fluid retention may disappear soon after diuretic therapy. [1] Finally, in some groups such as the obese, the elderly and chronic lung disease patients, the identification of symptoms and signs is even more difficult.…”

The myocardial remodeling at ischemic chronic heart failure: the features of Ivabradine influence in experimental model

“…У розвинутих країнах світу її частка становить 1-2 %, зростаючи з віком до 10 % і вище [1]. До того ж, дані численних епідеміологічних досліджень свідчать: серед ко-горти пацієнтів віком понад 65 років з ознаками утрудненого дихання в 1/6 випадків хибно не діагностується ХСН [2]. Установлено, що ризик захворіти на ХСН у віковій групі понад 55 років становить 33 % для чоловіків і 28 % -для жінок [2].…”

“…Під час морфометричного дослідження тварин ІІІ групи (їм вводили івабрадин) встановлене суттєве зменшення се-реднього значення показника площі профілю поперечного зрізу кардіоміоцитів, яке дорівнювало (299,88±7,71) мкм 2 , що вірогідно менше, ніж у тварин із модельованою ХСН, однак вірогідно перевищувало показники контролю. Під час збе-реження унімодального характеру розподілу кардіоміоцитів визначали зміщення піка гістограми у метричний інтервал (201,0-300,0) мкм Слід відзначити, що величина інтегрального показника ядерно-клітинного співвідношення суттєвих змін не зазна-вала й дорівнювала в середньому 0,089, що є вірогідно нижчим, ніж у контролі та вірогідно не відрізняється у тварин із ХСН.…”