Diagnosis of heart failure in elderly patients in primary care

Background: Heart failure is difficult to diagnose in a primary care settin g with a reported false positive diagnosis in up to 70% of cases. Aims: To use echocardiography in a large rural practice to evaluate the accuracy of diagnosis of heart failure in patients over 65 years of age. Methods: Sixty patients with a previous diagnosis of heart failure were selected at rando m from the practice records and were invited to attend for an echocardiogra m at the practice premises. Results: Fifty-eight patients attended, the age was 81 +/- 7 years, 29% had impaired left ventricular (LV) systolic functi on of whom 65% were in atrial fibrillation. A further 7% had isolated diast olic LV dysfunction. The prevalence of heart failure by clinical assessment was 29 per 1000 in this patient group and 9 per 1000 when echocardiography was used to confirm the diagnosis. Conclusion: True heart failure in this population is less prevalent than has been estimated from practice records. (C) 2001 European Society of Cardiology. All rights reserved.