Cross sectional study estimating prevalence of heart failure and left ventricular systolic dysfunction in community patients at risk

Objective-To examine a general practice population to measure the prevalenc e of signs and symptoms of heart failure (SSHF),and left ventricular systol ic dysfunction (LVSD). Design-Cross sectional screening study in three general practices followed by echocardiography. Setting and patients-All patients greater than or equal to 50 years in two general practices and greater than or equal to 40 years in one general prac tice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjec ts were sought who had SSHF (n = 115). Of 357 subjects with evidence of hea rt disease, 252 were eligible for examination, and 126 underwent further ca rdiological assessment, including 43 with SSHF Main outcome measures-Prevalence of SSHF as defined by a modified Boston in dex, LVSD defined as an indirectly measured left ventricular ejection fract ion less than or equal to 0.45, and numbers of subjects needing an echocard iogram to detect one case with LVSD. Results-SSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogen arians. Two thirds were handled in primary care only. At greater than or eq ual to 50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confiden ce interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 pati ents with SSHF had to be examined. Conclusion-SSHF is extremely prevalent in the community, especially in prim ary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect on e case of LVSD is 14.