Heart failure in patients seeking medical help at outpatients clinics. Part I. General characteristics

Background: During the last decade, the beneficial changes in lifestyle and in medical care increased average life expectancy, particularly in patient s with chronic diseases such as hypertension and coronary heart disease. Un fortunately this also increased the number of patients, particularly among the elderly, who are susceptible to complications of these conditions such as heart failure. Uncontrolled hypertension is known to be a primary cause of heart failure and is also known to be very prevalent and frequently unco ntrolled in the Polish population. Aim: To estimate the prevalence and char acteristics of heart failure among patients of 65 years and older seeking m edical care in outpatient clinics in Poland. Methods: The study is a cross- country epidemiological project in which 417 physicians from outpatient cli nics were asked to register 50 consecutive patients aged 65 years and above seeking medical care for any cause. Information on case history, physical examination (diagnosis of heart failure, NYHA class, heart failure symptoms ), laboratory tests (resting EGG, chest X-ray, echocardiogram) and data con cerning pharmacology management during the 2 weeks prior to the index visit was obtained. Results: Over 5 months, 19 877 eligible patients (7324 men a nd 12553 women) presented to the 417 participating physicians (90% physicia ns registered 46-50 patients). Among the patients, 53% were diagnosed with heart failure (3901 men and 6678 women), prevalence did not differ by gende r. Among patients with heart failure there were 38% of men in NYHA class II I or IV and 34% of women. Coronary heart disease was a predominant cause of heart failure in 87% of men (26% of cases with isolated coronary heart dis ease, 53% with concomitant hypertension and 8% with other diseases), while percentages for women were 80% (15%, 61% and 4%, respectively). Isolated hy pertension was a further cause of heart failure in 8% of men and 13% of wom en. Cardiac arrhythmia was found in approximately 20% of patients, enlargem ent of heart size in 32% of patients and peripheral leg edema in 54% of men and 64% of women. These symptoms increased with age. Chest X-ray revealed cardiomegaly in 68% of men and women and increased cardiothoracic ratio (> 50%) in approximately 40% of patients. From resting ECGs, cardiac arrhythmi a was recorded in 21% of patients with heart failure, with atrial fibrillat ion as a predominant disorder (19%). Left ventricular hypertrophy on restin g ECG was noted in 42% of men and women and old myocardial infarction or ca rdiac ischemia was diagnosed in 71% of men and 66% of women. Conclusions: ( 1) Heart failure was diagnosed in over half of outpatients aged 65 and olde r; in more than a third of these it was NYHA class III and IV. (2) Outpatie nts with heart failure had a high frequency of co-existing diseases such as arrhythmia, coronary heart disease and hypertension. (C) European Society of Cardiology. All rights reserved.