Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study

Background Accurate data for prevalence rates for heart failure due to vari ous causes, and for left-ventricular systolic dysfunction in all adults are unavailable. Our aim was to assess prevalence of left-ventricular systolic dysfunction and heart failure in a large representative adult population i n England. Methods Of 6286 randomly selected patients aged 45 years and older, 3960 (6 3%) participated in the study. They came from 16 randomly selected general practices. We assessed patients by history and examination, electrocardiogr aphy, and echocardiography. Prevalence of left-ventricular systolic dysfunc tion (defined as ejection fraction <40%) and heart failure was calculated f or the overall population on the basis of strict criteria and, when necessa ry, adjudication by a panel. Findings Left-ventricular systolic dysfunction was diagnosed in 72 (1.8% [9 5% CI 1.4-2.3]) participants, half of whom had no symptoms. Borderline left -ventricular function (ejection fraction 40-50%) was seen in 139 patients ( 3.5% [3.0-4.1]). Definite heart failure was seen in 92 (2.3%, [1.9-2.8]) an d was associated with an ejection fraction of less than 40% in 38 (41%) pat ients, atrial fibrillation in 30 (33%), and valve disease in 24 (26%). Prob able heart failure was seen in a further 32 (0.8% [0.6-1.1]) patients. In t otal, 124 (3.1% [2.6-3.7]) patients aged 45 years or older had definite or probable heart failure. Interpretation Heart failure is often misdiagnosed or underdiagnosed in pri mary care. Our results suggest that assessment of left-ventricular function in patients with suspected heart failure could lead to more effective diag nosis and treatment of this disorder.