Is the clinical presentation of chronic heart failure different in elderly versus younger patients and those with preserved versus reduced ejection fraction?

Autor: Micha T. Maeder, Beat A. Kaufmann, M Pfisterer, Hans-Peter Brunner-La Rocca, Peter Rickenbacher, Eva Steinmann
Přispěvatelé: RS: CARIM - R2.02 - Cardiomyopathy, MUMC+: MA Med Staf Spec Cardiologie (9), Cardiologie
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
FEATURES
Systolic function
Comorbidity
030204 cardiovascular system & hematology
Ventricular Dysfunction
Left
SYSTOLIC FUNCTION
0302 clinical medicine
Cost of Illness
030212 general & internal medicine
Prospective Studies
Aged
80 and over
OUTCOMES
Ejection fraction
medicine.diagnostic_test
Age Factors
Middle Aged
Heart failure with reduced ejection fraction
Clinical diagnosis
Heart failure with preserved ejection fraction
Cardiology
Female
TRIAL
Presentation (obstetrics)
medicine.medical_specialty
Physical examination
Heart failure
DIAGNOSIS
03 medical and health sciences
Internal medicine
Internal Medicine
medicine
MANAGEMENT
Humans
In patient
METAANALYSIS
Aged
business.industry
MORTALITY
Stroke Volume
medicine.disease
PHYSICAL-EXAMINATION
Logistic Models
Chronic Disease
Multivariate Analysis
business
Medical therapy
STANDARD MEDICAL THERAPY
Zdroj: European journal of internal medicine, 57, 61-69. Elsevier Science
ISSN: 1879-0828
0953-6205
DOI: 10.1016/j.ejim.2018.06.005
Popis: Background: Whether the clinical presentation and in particular prevalence of symptoms and signs of heart failure (HF) is different in elderly versus younger patients and in those with reduced (HFrEF) versus preserved (HFpEF) left ventricular ejection fraction (LVEF) is a matter of ongoing debate. Aims: To compare detailed clinical characteristics of these important subgroups and to develop a prediction rule for the differentiation of HFpEF and HFrEF based on clinical parameters. Methods: The analysis was based on the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) comprising 622 patients >= 60 years with HF including the whole LVEF spectrum. Results: In the groups >= 75 years and with HFpEF typical symptoms and clinical signs of HF were more prevalent as compared to those < 75 years or with HFrEF, respectively. The burden of comorbidities was higher in the older age group. HFrEF could not be differentiated from HFpEF by symptom history and clinical examination alone. However, a combination of age, presence of pulmonary rales, systolic blood pressure, cause of heart failure, osteoporosis, current smoking, NT-proBNP, haemoglobin, QRS width and heart rhythm allowed to identify HFrEF versus HFpEF with a sensitivity of 81% and specificity of 90% (c-statistics 0.91). Conclusions: More symptoms and signs of HF were present both in the older age group and in patients with HFpEF. HFpEF versus HFrEF could be differentiated by a set of simple clinical, laboratory and ECG parameters but not by symptom history and physical examination alone.
Databáze: OpenAIRE
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