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Heart failure often missed in the very elderly

One in four 87-89 year olds has significant undiagnosed LV dysfunction

Louise Prime

Wednesday, 25 July 2012

One in four very elderly people are suffering from undiagnosed heart disease that could be easily treated, research has revealed. Authors of the study – published today in Heart – said that home echocardiography to detect heart failure in over-85s with breathlessness would be cost-effective, and subsequent treatment would improve their quality of life.

As part of the Newcastle 85+ Study, the world’s biggest population-based longitudinal study of health and ageing in the over-85s, Newcastle University researchers visited 376 people aged 87-89 years in their homes or care homes and conducted echocardiography.

The most common problem detected was left ventricular systolic dysfunction with ejection fraction ≤50%, found in 32% of people. A further 20% had moderate or severe LV dysfunction with preserved ejection fraction.

About two-thirds of people with significant (systolic or isolated moderate/severe diastolic) LV dysfunction had limiting dyspnoea.

The study authors said: “84% of participants with significant LV dysfunction and limiting dyspnoea did not have a pre-existing [heart failure] diagnosis in their GP records. Overall, 26% of participants with both echocardiographic and dyspnoea data had undiagnosed, symptomatic, significant LV dysfunction.”

They concluded: “Significant systolic and diastolic LV dysfunction is much commoner in community dwelling 87-89 year olds than previous studies have suggested. The majority are both symptomatic and undiagnosed.”

Study lead Professor Bernard Keavney, a cardiologist at Newcastle University, admitted: “We were surprised to discover just how many older people have heart problems. Many of these people could be treated with drugs that we know work, if their condition were recognised.

“Our research suggests that it might be practical to offer people over 85 who are breathless, an echocardiogram at home which would reveal these problems. Because this heart problem occurs so often at this age, home checks are likely to be cost-effective, whereas they wouldn’t be in younger people …

“In those people found to have [LV dysfunction] on a home scan, medication could be considered. This would improve their quality of life and it’s likely to slow their progression to heart failure.”

He added: “With heart failure, prevention is definitely a priority. Older patients coming into hospital with worsening heart failure is one of the largest sources of expenditure for the NHS. The number of people over 85 is already soaring, and this will continue for the foreseeable future. So anything we can do to improve the heart health of our oldest old is likely to have a big impact.”

His co-author Dr Joanna Collerton also called for more trials involving older people, who are routinely excluded from trials of treatment.

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