CONGESTIVE-HEART-FAILURE IN THE COMMUNITY - A STUDY OF ALL INCIDENT CASES IN OLMSTED COUNTY, MINNESOTA, IN 1991

Background-Data are limited regarding the classification and prognosis of patients with congestive heart failure (CHF) in the community. Met hods and Results-Using the resources of the Rochester Epidemiology Pro ject, we evaluated all patients receiving a first diagnosis of CHF in Olmsted County, Minnesota, in 1991 (n=216). Among these patients, 88% were greater than or equal to 65 years and 49% were greater than or eq ual to 80 years of age. The prognosis of patients with a new diagnosis of CHF was poor; survival was 86+/-2% at 3 months, 76+/-3% at 1 year, and 35+/-3% at 5 years. Of the 216 patients, 137 (63%) had an assessm ent of ejection fraction. In these patients, systolic function was pre served (ejection fraction greater than or equal to 50%) in 59 (43%) an d reduced (ejection fraction <50%) in 78 (57%). Survival adjusted for age, sex, NYHA class, and coronary artery disease was not significantl y different between patients with preserved and those with reduced sys tolic function (relative risk, 0.80; P=0.369), ACE inhibitors were use d in only 44% of the total population with CHF. Conclusions-The presen t study reports the clinical characteristics and natural history of CH F as it presents in the community in the vasodilator era. CHF is a dis ease of the ''very elderly,'' frequently occurs in the setting of norm al ejection fraction, and has a poor prognosis, regardless of the leve l of systolic function. Diagnostic and therapeutic methods are underus ed in the community.