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Congestive heart failure in old age: prevalence, mechanisms and 4-year prognosis in the Helsinki Ageing Study
M Kupari1, M Lindroos, A M Iivanainen
1Department of Medicine, Helsinki University Central Hospital, Finland.
Insights
Congestive heart failure (CHF) affects 8.2% of the elderly, often due to heart disease or hypertension. CHF doubles the risk of all-cause mortality and quadruples cardiovascular death risk.
Area of Science:
- Gerontology
- Cardiology
- Epidemiology
Background:
- Congestive heart failure (CHF) is a significant health concern in the elderly population.
- Understanding the prevalence, causes, and outcomes of CHF in older adults is crucial for public health.
- Previous studies may not fully capture the specific characteristics of CHF in this demographic.
Purpose of the Study:
- To determine the prevalence of congestive heart failure (CHF) in individuals aged 75-86.
- To identify the underlying diseases contributing to CHF in the elderly.
- To assess left ventricular function and the 4-year prognosis, including mortality, for elderly patients with CHF.
Main Methods:
- A population-based study involving clinical assessments and echocardiography.
- Inclusion of 501 individuals born in 1904, 1909, and 1914.
- Four-year follow-up for total and cardiovascular mortality, with detailed echocardiographic analysis of cardiac function and valve disease.
Main Results:
- The prevalence of CHF was 8.2% (41 out of 501 participants).
- Ischemic heart disease, hypertension, and moderate-to-severe mitral or aortic valve disease were the primary underlying conditions (present in 90% of patients).
- A significant proportion of CHF patients (72%) exhibited normal left ventricular systolic function, with 51% classified as having 'diastolic CHF'.
- CHF was associated with a 2.1-fold increased risk of all-cause mortality and a 4.2-fold increased risk of cardiovascular mortality over 4 years.
Conclusions:
- CHF affects approximately 8% of individuals aged 75-86, primarily driven by ischemic heart disease, valvular disease, and hypertension.
- A substantial number of elderly CHF patients present with preserved left ventricular systolic function, highlighting the role of diastolic dysfunction.
- Congestive heart failure significantly increases long-term mortality risk in the elderly, underscoring the need for targeted interventions.
Objective:
To examine the prevalence, underlying diseases, abnormalities of left ventricular function and prognosis in congestive heart failure (CHF) of old age.
Design:
A population-based clinical and echocardiographic study with a 4-year mortality follow-up.
Setting:
University hospital.
Subjects:
Five hundred and one individuals born in 1904. 1909 and 1914 (367 women).
Main Outcome Measures:
Presence of CHF by clinical and chest radiograph criteria: left ventricular size and systolic function by echocardiography; grade of aortic and mitral valve lesion by Doppler echocardiography; 4-year total and cardiovascular mortality.
Results:
Forty-one of 501 participants (8.2%) had CHF. Ischaemic heart disease (54%), hypertension (54%) and moderate-to-severe mitral or aortic valve disease (51%) were the main underlying conditions; 90% of patients had one or more of these diseases. Most individuals with CHF (28 of 39 patients, 72%) had normal left ventricular contractions at echocardiography. 'Diastolic CHF', defined as CHF with normal systolic left ventricular function and no regurgitant valve disease, was found in 51% (20 of 39 patients). The relative 4-year risk for death associated with CHF, adjusted for age and sex, was 2.1 (95% confidence interval 1.3-3.4) for all-cause mortality and 4.2 (CI 1.9-5.6) for cardiovascular mortality.
Conclusions:
The prevalence of CHF in a population aged 75-86 years is approximately 8%. Ischaemic or valvular heart disease and hypertension are the main underlying conditions. At echocardiography, about 50% of the elderly with CHF have normal left ventricular systolic contractions in the absence of valve disease and an additional 20% have normal systolic function with mitral regurgitation. The presence of CHF doubles the age- and sex-adjusted risk of death from all causes, and quadruples the risk of cardiovascular death during 4-year follow-up.