Congestive heart failure due to diastolic or systolic dysfunction - Frequency and patient characteristics in an ambulatory setting

Objective: To determine the age- and sex-specific frequencies and character istics of patients with diastolic and systolic dysfunction heart failure. Design: Retrospective medical record survey encompassing 1 year. Setting: Community-based family practice office. Patients: One hundred thirty-six patients who met the modified Framingham c riteria for the diagnosis of congestive heart failure (CHF) and had a known left ventricular ejection fraction. Diastolic dysfunction was defined as a n ejection fraction of 45% or greater and systolic dysfunction heart failur e as an ejection fraction of less than 45%. Main Outcome Measures: Age- and sex-specific frequency; patient comorbid conditions; medications taken; an d number of emergency department visits, hospitalizations, and deaths. Results: The frequency of CHF increased with age for men and women (1.3% fo r patients 45-54 years old to 8.8% for patients >75 years old). The distrib ution according to left ventricular ejection fraction and age varied accord ing to sex. Women had later onset of CHF that was predominantly diastolic d ysfunction heart failure. Men had proportionately more systolic dysfunction heart failure at all ages. Forty percent of all patients with CHF had dias tolic heart failure, and these patients had fewer functional limitations (7 6% with New York Heart Association classes I and II), fewer hospitalization s for CHF, and a trend toward fewer deaths during the study year compared w ith patients with systolic dysfunction. Conclusions: Congestive heart failure is a heterogeneous condition in this family practice setting, and diastolic dysfunction heart failure occurs fre quently. Further study of the natural history and treatment of diastolic dy sfunction heart failure should be performed in the primary care setting.