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Left ventricular systolic dysfunction and atrial fibrillation in older people in the community--a need for screening?
Shu F Ho1, M Sinead O'Mahony, John A Steward
1University Department of Geriatric Medicine, Llandough Hospital, Cardiff, UK.
Insights
Older adults have high rates of left ventricular systolic dysfunction and atrial fibrillation. Treatments like ACE inhibitors and anticoagulants are underused, despite regular healthcare contact, increasing risks for heart failure and stroke.
Area of Science:
- Cardiology
- Geriatrics
- Public Health
Background:
- Heart failure and stroke are leading causes of death in the elderly.
- ACE inhibitors improve outcomes in left ventricular systolic dysfunction.
- Anticoagulants are crucial for stroke prevention in atrial fibrillation.
Purpose of the Study:
- Assess prevalence of left ventricular systolic dysfunction and atrial fibrillation in community-dwelling older adults.
- Evaluate health service utilization and medication prescribing for these conditions.
- Determine rates of ACE inhibitor and anticoagulant/antiplatelet therapy.
Main Methods:
- Two-stage random sampling of 5,002 individuals aged 70+.
- Electrocardiography and echocardiography used for screening.
- 500 subjects included in the final analysis.
Main Results:
- Prevalence: 9.8% for left ventricular systolic dysfunction, 7.8% for atrial fibrillation.
- Under-treatment: Over two-thirds with left ventricular systolic dysfunction not on ACE inhibitors.
- Atrial fibrillation treatment: 35% on aspirin, 24% on warfarin, 41% on neither.
Conclusions:
- Left ventricular systolic dysfunction is significantly under-treated in the elderly population.
- Despite frequent healthcare interactions, many patients with atrial fibrillation lack stroke prevention therapy.
- There is a critical need to improve management of these cardiovascular conditions in older adults.
Background:
Heart failure and stroke are major causes of morbidity and mortality in older people. Angiotensin converting enzyme inhibitors improve symptoms and survival in left ventricular systolic dysfunction. Anticoagulants are effective in stroke prevention in atrial fibrillation with aspirin being a less effective alternative.
Objectives:
To determine the prevalence of left ventricular systolic dysfunction, health services utilisation and prescribing of diuretics and angiotensin converting enzyme inhibitors in left ventricular systolic dysfunction, and the prevalence of atrial fibrillation and anti-platelet/thrombotic therapy in atrial fibrillation in older people in the community.
Methods:
500 subjects were drawn by two-stage random sampling from 5,002 subjects aged 70 years and over living at home. Subjects were screened for atrial fibrillation and left ventricular systolic dysfunction using electrocardiography and echocardiography.
Results:
The population prevalence amongst older people of left ventricular systolic dysfunction was 9.8% and of atrial fibrillation 7.8%. More than two-thirds of those with left ventricular systolic dysfunction were not on angiotensin converting enzyme inhibitors. Of those in atrial fibrillation, 35% were taking aspirin, 24% were taking warfarin and 41% were on neither aspirin nor warfarin. Nearly 90% of older people in the community have had contact with their general practitioner over the past year, and over half of those with left ventricular systolic dysfunction have had contact with hospital-based services over the past 2 years.
Conclusions:
Left ventricular systolic dysfunction is under-treated in older people in the community. Despite the high level of contact with hospital and community-based services, the majority of those with systolic left ventricular dysfunction are not on angiotensin converting enzyme inhibitors and a significant proportion of those in atrial fibrillation are not on any treatment for stroke prevention.
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