Prevalence of left ventricular dysfunction in a UK community sample of very old people: the Newcastle 85+ study
- Fahad Yousaf1,
- Joanna Collerton1,
- Andrew Kingston1,
- Antoinette Kenny2,
- Karen Davies1,
- Carol Jagger1,
- Louise Robinson1,3,
- Thomas B L Kirkwood1,
- Bernard Keavney4
- 1Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
- 2Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- 3Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- 4Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
- Correspondence to Dr J Collerton, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK; joanna.collerton{at}ncl.ac.uk
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Contributors FY participated in: literature review; development of cardiac phenotyping protocols; data collection; data preparation; data analysis and interpretation; and critical review of the paper drafts. JC participated in: study design; literature review; supervision of the data collection; data preparation; data analysis and interpretation; and development and writing of the paper. AK participated in: data preparation; statistical analysis and interpretation of the data; and critical review of the paper drafts. AKe participated in: development of cardiac phenotyping protocols; supervision of the data collection; data analysis and interpretation; and critical review of the paper drafts. KD participated in: participant recruitment; supervision of the data collection; data preparation; and critical review of the paper drafts. CJ participated in: development of the protocols; supervision of the data collection; supervision of the statistical analysis; and critical review of the paper drafts. LR participated in: development of the protocols; data collection; and critical review of the paper drafts. TBLK participated in: overall leadership and supervision of the Newcastle 85+ Study; and critical review of the paper drafts. BK participated in: conception and design of the study; literature review; obtaining funding; development of the cardiac phenotyping protocols; supervision of the data collection; data analysis and interpretation; and the development and writing of the paper.
- Accepted 28 June 2012
- Published Online First 2 August 2012
Abstract
Objective Heart failure (HF) prevalence rises sharply among those aged 85 years and over. Previous population based echocardiographic studies of left ventricular (LV) dysfunction, the substrate for HF, have included only small numbers in this age group. We used domiciliary echocardiography to estimate the prevalence of LV systolic and diastolic dysfunction in 87–89 year olds and the proportion remaining undiagnosed.
Design Cross sectional analysis of data from Newcastle 85+ Study.
Setting Primary care, North-East England.
Participants 376 men and women aged 87–89 years.
Measures Domiciliary echocardiography was performed and LV systolic and diastolic function was graded. The presence of limiting dyspnoea was assessed by questionnaire. Previous diagnoses of HF were abstracted from general practice (GP) records.
Results 32% of participants (119/376) had LV systolic dysfunction (ejection fraction (EF) ≤50%) and a further 20% (75/376) had moderate or severe LV diastolic dysfunction with preserved EF. Both echocardiographic assessment of LV function and dyspnoea status were available in 74% (278/376) of participants. Among these participants, limiting dyspnoea was present in approximately two thirds of those with significant (systolic or isolated moderate/severe diastolic) LV dysfunction. 84% (73/87) of participants with significant LV dysfunction and limiting dyspnoea did not have a pre-existing HF diagnosis in their GP records. Overall, 26% (73/278) of participants with both echocardiographic and dyspnoea data had undiagnosed, symptomatic, significant LV dysfunction.
Conclusion 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.
Footnotes
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FY and JC contributed equally to this manuscript.
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Funding This work was supported by the British Heart Foundation (PG/08/026/24 712). The core Newcastle 85+ Study was supported by: UK Medical Research Council and Biotechnology and Biological Sciences Research Council (G0500997); Dunhill Medical Trust (R124/0509); and NHS North of Tyne (Newcastle Primary Care Trust). BK is supported by a British Heart Foundation Personal Chair. The funders had no role in the study design; in the collection, analysis or interpretation of the data; in the writing of the paper; or in the decision to submit the paper for publication. The work was supported by the UK NIHR Biomedical Research Centre for Age and Age Related Disease award to the Newcastle upon Tyne Hospitals NHS Foundation Trust.
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Competing interests None.
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Ethics approval The study was approved by the Newcastle and North Tyneside 1 research ethics committee (reference No 06/Q0905/2).
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Provenance and peer review Not commissioned; externally peer reviewed.
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