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Congestive heart failure due to diastolic or systolic dysfunction. Frequency and patient characteristics in an
P M Diller1, D R Smucker, B David
1Department of Family Medicine, College of Medicine, University of Cincinnati, Ohio, USA.
Insights
Congestive heart failure (CHF) is diverse, with diastolic dysfunction heart failure being common, especially in older women. This study highlights differences in CHF presentation by sex and age in primary care.
Area of Science:
- Cardiology
- Primary Care Medicine
- Epidemiology
Background:
- Congestive heart failure (CHF) is a significant public health concern.
- Understanding the specific types of heart failure, such as diastolic and systolic dysfunction, is crucial for effective management.
- Age and sex are known factors influencing heart failure prevalence and characteristics.
Purpose of the Study:
- To investigate the age- and sex-specific frequencies of diastolic and systolic dysfunction heart failure.
- To characterize patients with different types of heart failure in a primary care setting.
- To analyze comorbidities, medications, and healthcare utilization in heart failure patients.
Main Methods:
- Retrospective survey of medical records from a community-based family practice over one year.
- Inclusion of 136 patients meeting modified Framingham criteria for CHF with known left ventricular ejection fraction (LVEF).
- Classification of diastolic dysfunction (LVEF ≥ 45%) and systolic dysfunction (LVEF < 45%).
Main Results:
- CHF frequency increased with age, affecting 8.8% of individuals over 75.
- Women experienced later onset of CHF, predominantly diastolic dysfunction.
- Men showed a higher proportion of systolic dysfunction across all age groups.
- Diastolic heart failure (40% of cases) was associated with fewer limitations and hospitalizations compared to systolic dysfunction.
Conclusions:
- Congestive heart failure is a heterogeneous condition within primary care.
- Diastolic dysfunction heart failure is prevalent and requires further investigation.
- Primary care settings are vital for studying the natural history and treatment of diastolic heart failure.
Objective:
To determine the age- and sex-specific frequencies and characteristics of patients with diastolic and systolic dysfunction heart failure.
Design:
Retrospective medical record survey encompassing 1 year.
Setting:
Community-based family practice office.
Patients:
One hundred thirty-six patients who met the modified Framingham criteria for the diagnosis of congestive heart failure (CHF) and had a known left ventricular ejection fraction. Diastolic dysfunction was defined as an ejection fraction of 45% or greater and systolic dysfunction heart failure as an ejection fraction of less than 45%.
Main Outcome Measures:
Age- and sex-specific frequency; patient comorbid conditions; medications taken; and number of emergency department visits, hospitalizations, and deaths.
Results:
The frequency of CHF increased with age for men and women (1.3% for patients 45-54 years old to 8.8% for patients > 75 years old). The distribution according to left ventricular ejection fraction and age varied according to sex. Women had later onset of CHF that was predominantly diastolic dysfunction heart failure. Men had proportionately more systolic dysfunction heart failure at all ages. Forty percent of all patients with CHF had diastolic heart failure, and these patients had fewer functional limitations (76% with New York Heart Association classes I and II), fewer hospitalizations for CHF, and a trend toward fewer deaths during the study year compared with patients with systolic dysfunction.
Conclusions:
Congestive heart failure is a heterogeneous condition in this family practice setting, and diastolic dysfunction heart failure occurs frequently. Further study of the natural history and treatment of diastolic dysfunction heart failure should be performed in the primary care setting.