The clinical features of heart failure in elderly and old age

Abstract

The aim of the study. To evaluate the prevalence and clinico-functional features of myocardial dysfunction in persons 65 years or older in the primary care setting. Materials and methods. The prospective cohort study Crystal included participants 65 years and older. The arm of "Crystal study evaluated a random sample size of 284 people. All participants were performed echocardiography using portable digital ultrasound scanner MindrayM5 ultrasound transducer of 2.5-3.5 MHz. It was also evaluated the clinical manifestations of heart failure (HF) on the scale SHOCKS, medical history and anthropometric data and parameters of the geriatric examination. Were determined muscle strength, walking speed, emotional status (Geriatric Depression Scale) and cognitive status (Mini-Mental State Examination). Assessment of dependence on external assistance was carried out based on the Barthel Index (Barthel Index). Results. The prevalence of all forms of myocardial dysfunction was 80.3%, among them of 73.2% of participants had clinical manifestations of heart failure, which was not associated with type or severity of structural and functional abnormalities of the myocardium. Symptoms and signs of HF were characterized by low sensitivity for detection in older people with MD and may be associated with other conditions. The most common complaint was shortness of breath (59%), with high sensitivity for the diagnosis (89%) but low specificity (51%). Patients with clinical manifestations of HF are more likely to have a BMI of over 30 kg/m∗, cognitive disorders, suspected depression, lower walking speed and low grip strength by dynamometry. In addition, participants with symptoms were older age (75,3±5.6 years vs 72,7±5.5 years, pcO.OOl). The analysis showed a significant negative effect of MD on survival of participants in the study: overall risk of mortality in participants with myocardial dysfunction aged 65-74 years was higher than 4.8, and at age 75 and over 2.9 times. The conclusion Low diagnostic value of symptoms of heart failure in the population older people were demonstrated. The need for a full geriatric examination at the outpatient stage in combination with early holding of echocardiography to persons with suspected myocardial dysfunction of the myocardium was showed, in connection with negative prognostic impact.