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.
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.
Authors: Susana Garcia-Gutierrez; José Maria Quintana; Ane Antón-Ladislao; Maria Soledad Gallardo; Esther Pulido; Irene Rilo; Elena Zubillaga; Miren Morillas; José Juan Onaindia; Nekane Murga; Ricardo Palenzuela; José González Ruiz Journal: Intern Emerg Med Date: 2016-10-11 Impact factor: 3.397
Authors: Dani Kim; Benedict Hayhoe; Paul Aylin; Azeem Majeed; Martin R Cowie; Alex Bottle Journal: Br J Gen Pract Date: 2019-09-26 Impact factor: 5.386
Authors: Mark J Valk; Arend Mosterd; Berna Dl Broekhuizen; Nicolaas Pa Zuithoff; Marcel Aj Landman; Arno W Hoes; Frans H Rutten Journal: Br J Gen Pract Date: 2016-06-06 Impact factor: 5.386