Importance of heart failure with preserved systolic function in patients >= 65 years at age

Although congestive heart failure (CHF) is a common syndrome among the elde rly, there is a relative paucity of population-based data, particularly reg arding CHF with normal systolic left ventricular function. A total of 4,842 independent living, community-dwelling subjects aged 66 to 103 years recei ved questionnaires on medical history, family history, personal habits, phy sical activity, and socioeconomic status, confirmation of preexisting cardi ovascular and cerebrovascular disease, anthropometric measurements, casual seated random-zero blood pressure, forced vital capacity and expiratory vol ume in 1 second, 12-lead supine electrocardiogram, fasting glucose, creatin ine, plasma lipids, carotid artery wall thickness by ultrasonagraphy, and e chocardiography-Doppler examinations. participants with at least 1 confirme d episode of CHF by Cardiovascular Health Study criteria were considered pr evalent for CHF. The prevalence of CHF was 8.8% and was associated with inc reased age, particularly for women, in whom it increased more than twofold from age 65 to 69 years (6.6%) to age greater than or equal to 85 years (14 %). In multivariate analysis, subjects with CHF were more likely to be olde r (odds ratio [OR] 1.2 for 5-year difference, men OR 1.1), and more often h ad a history of myocardial infarction (OR 7.3), atrial fibrillation (OR 3.0 ), diabetes mellitus (OR 2.1), renal dysfunction (OR 2.0 for creatinine gre ater than or equal to1.5 mg/dl), and chronic pulmonary disease (OR 1.8; wom en only). The echocardiographic correlates of CHF were increased left atria l and ventricular dimensions. Importantly, 55% of subjects with CHF had nor mal left ventricular systolic function and 80% had either normal or only mi ldly reduced systolic function. Among subjects with CHF, women held normal systolic function more frequently than men (67% vs 42%; p < 0.001). Thus, C HF is common among community-dwelling elderly. It increases with age and is usually associated with normal systolic LV function, particularly among wo men. The finding that a large proportion of elderly with CHF have preserved LV systolic function is important because there is a paucity of data to gu ide management in this dominant subset. (C) 2001 by Excerpta Medica, Inc.