Diagnosing heart failure in centenarians

As a consequence of the demographic development with increasing proportion of older people, the prevalence of heart failure (HF) is expected to rise with considerable economic and societal costs. However, knowledge on cardiac structure and function among population-based samples of the exceptional old is lacking.

Population-based study of all persons (no exclusion criteria) living in the western part of Denmark and turning 100 years in the year 2015. In-home face-to-face interviews were conducted, and echocardiography and blood sampling for plasma Brain Natriuretic Peptide (BNP) were offered to those who were able to give consent.

Out of 303 eligible, 238 (79%) participated, of which 125 (53%) accepted echocardiography. Left ventricular (LV) dysfunction was present in 68 (54%) of the participants of whom less than half had HF symptoms. Pulmonary hypertension was present in 31 (42%) with no correlation to LV function. The well-known association between increased level of BNP and the prevalence of LV dysfunction could not be confirmed.

This in-home echocardiographic study shows that more than half of the participants had LV dysfunction, although mostly asymptomatic. There was no association between heart failure symptoms and LV dysfunction. Furthermore, BNP seems to have lost its biomarker potential to rule out heart failure in centenarians. Due to the latter, and the questionable symptom validity among centenarians, the current criteria to diagnose HF might be less valid in a centenarian population than in younger olds.