Prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in general practice setting: cross sectional survey

Objective To assess the prevalence and clinical characteristics of left ven tricular dysfunction among elderly patients in the general practice setting by echocardiographic assessment of ventricular function. Design Cross sectional survey. Setting Four centre general practice in Poole, Dorset. Subjects 817 elderly patients aged 70-84 years. Main outcomes Echocardiographic assessment of left ventricular systolic fun ction including measurement of ejection fraction by biplane summation metho d where possible, clinical symptoms, and signs of left ventricular dysfunct ion. Results The overall prevalence of left ventricular systolic dysfunction was 7.5% (95% confidence interval 5.8% to 9.5%); mild dysfunction (5.0%) was c onsiderably more prevalent than moderate (1.6%) or severe dysfunction (0.7% ). Measurement of ejection fraction was possible in 82% of patients (n = 66 7): in patients categorised as having mild, moderate, or severe dysfunction , the mean ejection fraction was 48% (SD 12.0), 38% (8.1), and 26% (7.9) re spectively. At all ages the prevalence was much higher in men than in women (odds ratio 5.1, 95% confidence interval 2.6 to 10.1). No clinical symptom or sign was both sensitive and specific In around half the patients with v entricular dysfunction (52%, 32/61) heart failure had not been previously d iagnosed. Conclusions Unrecognised left ventricular dysfunction is a common problem i n elderly patients in the general practice setting. Appropriate treatment w ith angiotensin converting enzyme inhibitors has the potential to reduce ho spitalisation and mortality in these patients, hut diagnosis should not be based on clinical history and examination alone. Screening is feasible in g eneral practice, but it should not be implemented until the optimum method of identifying left ventricular dysfunction is clarified, and the cost effe ctiveness of screening has been shown.