Congestive heart failure in old age: prevalence, mechanisms and 4‐year prognosis in the Helsinki Ageing Study

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.