Prevalence of Unrecognized Heart Failure in Older Persons with Shortness of Breath on Exertion

Evelien E.S. van Riet; Arno W. Hoes; Alexander Limburg; Marcel A.J. Landman; Henk van der Hoeven; Frans H. Rutten

doi:10.1002/ejhf.110

journal article May 26, 2014

Prevalence of Unrecognized Heart Failure in Older Persons with Shortness of Breath on Exertion

Evelien E.S. van Riet Arno W. Hoes

Alexander Limburg Marcel A.J. Landman Henk van der Hoeven Frans H. Rutten

European Journal of Heart Failure Vol. 16 No. 7 pp. 772-777 · Oxford University Press (OUP)

View at Publisher Save 10.1002/ejhf.110

Abstract

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 (&gt;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.

Topics

No keywords indexed for this article. Browse by subject →

References

34

[1]

Schocken "Prevention of Heart Failure: a Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group" Circulation (2008) 10.1161/circulationaha.107.188965

[2]

Mann "Mechanisms and models in heart failure: the biomechanical model and beyond" Circulation (2005) 10.1161/circulationaha.104.500546

[3]

New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part II

Michael R. Zile, Dirk L. Brutsaert

Circulation 2002 10.1161/hc1202.105290

[4]

Mosterd "Clinical epidemiology of heart failure" Heart (2007) 10.1136/hrt.2003.025270

[5]

Anguita "Prevalence of heart failure in the Spanish general population aged cver 45 years. The PRICE Study" Rev Esp Cardiol (2008)

[6]

Boonman-de Winter "High Prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes" Diabetologia (2012) 10.1007/s00125-012-2579-0

[7]

Ceia "A. Prevalence of chronic heart failure in southwestern Europe: the EPICA Study" Eur J Heart Fail (2002) 10.1016/s1388-9842(02)00034-x

[8]

Rutten "Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease" Eur Heart J (2005) 10.1093/eurheartj/ehi291

[9]

Barents "Prevalence and misdiagnosis of chronic heart failure in nursing home residents: the role of B-Type natriuretic peptides" Neth Heart J (2008) 10.1007/bf03086130

[10]

Remes "Validity of clinical diagnosis of heart failure in primary health care" Eur Heart J (1991) 10.1093/oxfordjournals.eurheartj.a059896

[11]

Wheeldon "Echocardiography in chronic heart failure in the community" Q J Med (1993)

[12]

Predictors of chronic breathlessness: a large population study

Jacqueline A Bowden, Timothy HM To, Amy P Abernethy et al.

BMC Public Health 2011 10.1186/1471-2458-11-33

[13]

Landahl "Dyspnea in 70-year-old people" Acta Med Scand (1980) 10.1111/j.0954-6820.1980.tb09710.x

[14]

McMurray "ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in Collaboration With the Heart Failure Association (HFA) of the ESC" Eur J Heart Fail (2012) 10.1093/eurjhf/hfs105

[15]

Rose (1982)

[16]

Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology

Roberto M. Lang, Michelle Bierig, Richard B. Devereux et al.

Journal of the American Society of Echocardiograph... 2005 10.1016/j.echo.2005.10.005

[17]

Nagueh "Recommendations for the evaluation of left ventricular diastolic function by echocardiography" J Am Soc Echocardiogr (2009) 10.1016/j.echo.2008.11.023

[18]

Schiller "Recommendations for quantitation of the left ventricle by Two-Dimensional Echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms" J Am Soc Echocardiogr (1989) 10.1016/s0894-7317(89)80014-8

[19]

Quinones "A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography" Circulation (1981) 10.1161/01.cir.64.4.744

[20]

Paulus "How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology" Eur. Heart J (2007) 10.1093/eurheartj/ehm037

[21]

Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method.

R B Devereux, N Reichek

Circulation 1977 10.1161/01.cir.55.4.613

[22]

Bui "Epidemiology and risk profile of heart failure" Nat Rev Cardiol (2011) 10.1038/nrcardio.2010.165

[23]

Lee "Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the Framingham Heart Study of the National Heart, Lung, and Blood Institute" Circulation (2009) 10.1161/circulationaha.108.815944

[24]

Lenzen "Differences between patients with a preserved and a depressed left ventricular function: a Report From the EuroHeart Failure Survey" Eur. Heart J (2004) 10.1016/j.ehj.2004.06.006

[25]

Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction

Theophilus E. Owan, David O. Hodge, Regina M. Herges et al.

New England Journal of Medicine 2006 10.1056/nejmoa052256

[26]

Owan "Epidemiology of diastolic heart failure" Prog Cardiovasc Dis (2005) 10.1016/j.pcad.2005.02.010

[27]

Epidemiology and Clinical Course of Heart Failure with Preserved Ejection Fraction

Carolyn S.P. Lam, Erwan Donal, Elisabeth Kraigher-Krainer et al.

European Journal of Heart Failure 2011 10.1093/eurjhf/hfq121

[28]

Redfield "Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic" JAMA (2003) 10.1001/jama.289.2.194

[29]

Zaphiriou "The diagnostic accuracy of plasma BNP and NTproBNP in patients referred from primary care with suspected heart failure: results of the UK Natriuretic Peptide Study" Eur J Heart Fail (2005) 10.1016/j.ejheart.2005.01.022

[30]

Aurigemma "Clinical practice. Diastolic heart gailure" N Engl J Med (2004) 10.1056/nejmcp022709

[31]

van Veldhuisen "B-Type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction" J Am Coll Cardiol (2013) 10.1016/j.jacc.2012.12.044

[32]

Paulus "Novel strategies in diastolic heart failure" Heart (2010) 10.1136/hrt.2009.169052

[33]

A Novel Paradigm for Heart Failure With Preserved Ejection Fraction

Walter J. Paulus, Carsten Tschöpe

Journal of the American College of Cardiology 2013 10.1016/j.jacc.2013.02.092

[34]

Paulus "Treatment of heart failure with normal ejection fraction: an inconvenient truth!" J Am Coll Cardiol. (2010) 10.1016/j.jacc.2009.06.067

Cited By

233

Heart failure with preserved ejection fraction

Carine E. Hamo, Colette DeJong · 2024

Nature Reviews Disease Primers

Evaluation of left atrial dysfunction by speckle tracking echocardiography in systolic and diastolic heart failure

Ahmed Ghanaym, Khaled Elkhashab · 2022

Monaldi Archives for Chest Disease

Prevalence, Characteristics, Management and Outcomes of Patients with Heart Failure with Preserved, Mildly Reduced, and Reduced Ejection Fraction in Spain

Carlos Escobar, Beatriz Palacios · 2022

Journal of Clinical Medicine

Metrics

233

Citations

34

References

Details

Published: May 26, 2014
Vol/Issue: 16(7)
Pages: 772-777
License: View

Authors

E

Evelien E.S. van Riet

Julius Center for Health Sciences and Primary care, University Medical Center Utrecht , PO Box 85500, 3508 AB, Utrecht ,

A

Arno W. Hoes

Julius Center for Health Sciences and Primary care, University Medical Center Utrecht , PO Box 85500, 3508 AB, Utrecht ,

A

Alexander Limburg

Diakonessenhuis Zeist , Zeist ,

M

Marcel A.J. Landman

Meander Medical Center , Amersfoort ,

H

Henk van der Hoeven

Diakonessenhuis Zeist , Zeist ,

F

Frans H. Rutten

Julius Center for Health Sciences and Primary care, University Medical Center Utrecht , PO Box 85500, 3508 AB, Utrecht ,

Funding

Hartstichting Award: 2009B048

Cite This Article

Evelien E.S. van Riet, Arno W. Hoes, Alexander Limburg, et al. (2014). Prevalence of Unrecognized Heart Failure in Older Persons with Shortness of Breath on Exertion. European Journal of Heart Failure, 16(7), 772-777. https://doi.org/10.1002/ejhf.110

Prevalence of Unrecognized Heart Failure in Older Persons with Shortness of Breath on Exertion

You May Also Like