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Prevalence of Left Ventricular Dysfunction in a UK Community Sample of Very Old People: The Newcastle 85+ Study
Study Questions:
What is the prevalence of left ventricular dysfunction (LVD) in those ≥85 years of age?
Methods:
This was a secondary analysis from the 85+ plus study, a population-based longitudinal study of health and aging in individuals over 84 years of age. Echocardiograms were done at 18 and 36 months after enrollment. A dyspnea questionnaire was administered and patients were categorized as “no limiting dyspnea,” “limiting dyspnea, or “unclassifiable.”
Results:
There were 376 of the total 528 patients in the Newcastle 85+ Study with echocardiography data who were included in the analysis. The mean patient age was 87.9 ± 0.4 years, 62% were female, 44% had a history of ischemic heart disease, 58% hypertension, 2.7% severe renal failure, and 13% had diabetes. LV systolic dysfunction (ejection fraction [EF] ≤50%) was present in 32% (n = 119/376) and 20% had moderate or severe LV diastolic dysfunction with a preserved LVEF. Limiting dyspnea was reported in 63% of patients (n = 57/90) with systolic dysfunction and 60% (n = 30/50) of patients with moderate or severe diastolic dysfunction. Only 10% of patients identified to have systolic heart failure (HF) or moderate/severe diastolic dysfunction carried a pre-existing diagnosis of HF; 26% of patients with limiting dyspnea had undiagnosed LVD.
Conclusions:
The authors concluded that LVD is common in those over 85 years of age, and many patients with symptomatic HF are undiagnosed.
Perspective:
This study is a rare analysis of HF burden in those of very advanced age. Both systolic and diastolic HF were prevalent, and most symptomatic patients appeared to have been undiagnosed. It is possible that imaging was never undertaken because practitioners either did not feel a confirmatory diagnosis would change management or would impact patient outcome. It would be interesting to learn whether patients who carried an HF diagnosis had a different survival from those HF patients without a prior diagnosis, or if ascription of a ‘diagnosis’ led to changes in quality of life.
Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Chronic Heart Failure, Echocardiography/Ultrasound, Hypertension
Keywords: Myocardial Ischemia, Dyspnea, Heart Failure, Systolic, Systole, Heart Diseases, Prevalence, Renal Insufficiency, Diastole, Ventricular Dysfunction, Left, Diabetes Mellitus, Hypertension, Echocardiography
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