CONGESTIVE-HEART-FAILURE IN OLD-AGE - PREVALENCE, MECHANISMS AND 4-YEAR PROGNOSIS IN THE HELSINKI AGING STUDY

Objective. To examine the prevalence, underlying diseases, abnormaliti es of left ventricular function and prognosis in congestive heart fail ure (CHF) of old age. Design. A population-based clinical and echocard iographic study with a 4-year mortality followup. Setting. University hospital. Subjects, Five hundred and one individuals born in 1904, 190 9 and 1914 (367 women). Main outcome measures. Presence of CHF by clin ical and chest radiograph criteria; left ventricular size and systolic function by echocardiography; grade of aortic and mitral valve lesion s by Doppler echocardiography; 4-year total and cardiovascular mortali ty. Results. Forty-one of 501 participants (8.2%) had CHF. Ischaemic h eart disease (54%), hypertension (54%) and moderate-to-severe mitral o r aortic valve disease (51%) were the main underlying conditions; 90% of patients had one or more of these diseases. Most individuals with C HF (28 of 39 patients, 72%) had normal left ventricular contractions a t echocardiography. 'Diastolic CHF', defined as CHF with normal systol ic left ventricular function and no regurgitant valve disease, was fou nd in 51% (20 of 39 patients). The relative 4-year risk for death asso ciated with CHF, adjusted for age and sex, was 2.1 (95% confidence int erval 1.3-3.4) for all-cause mortality and 4.2 (CI 1.9-5.6) for cardio vascular mortality. Conclusions. The prevalence of CHF in a population aged 75-86 years is approximately 8%. Ischaemic or valvular heart dis ease and hypertension are the main underlying conditions. At echocardi ography, about 50% of the elderly with CHF have normal left ventricula r systolic contractions in the absence of valve disease and an additio nal 20% have normal systolic function with mitral regurgitation. The p resence of CHF doubles the age- and sex-adjusted risk of death from al l causes, and quadruples the risk of cardiovascular death during 4-yea r follow-up.