Key result
Clinical signs, chest X-rays, and abnormal ECGs had low specificities for diagnosing heart failure (50%, 20%, and 9%, respectively) in frail elderly patients with multiple comorbidities.
Observational (n=116)
In frail elderly patients with heart failure, diagnosis is difficult due to low specificity of standard clinical signs and investigations, and management is complicated by universal multimorbidity and polypharmacy.
Standard diagnostics warrant caution in frail elderly; leaves open refined HF criteria for multimorbid patients.
BACKGROUND: Heart failure (HF) is difficult to diagnose and treat in older patients. Symptoms may be non-specific and the presence of co-morbidities and polypharmacy complicate treatment strategies. There are, however, few data to quantify the extent of these problems in the very elderly. METHODS: A retrospective study of 116 patients (median age 86; range 65-98) with an established diagnosis of HF during their hospital admission. MAIN OUTCOME MEASURES: the accuracy of diagnosis of heart failure according to the European Society of Cardiology (ESC) definition. The aetiology and frequency of associated co-morbidities and the nature of drug treatment. RESULTS: The specificities of clinical signs, chest X-rays and abnormal ECGs for heart failure (ESC definition) were 50%, 20% and 9%, respectively. Only 28% of patients were admitted for worsening symptoms which could be attributed to HF. None of the patients had HF as their only medical problem. Co-morbidities included chest disease (30%), incontinence (29%), cerebrovascular disease (26%), musculoskeletal problems (41%). Barthel (activities of daily living) score was < or = 16/20 in 35%. Mental state questionnaire (MSQ) score was < or =7/10 in 38%. Ninety percent were taking four or more different medications. Thirty-nine percent were on psychotropic drugs. On discharge, a total of 88% of patients returned home to live independently and 35% were monitored by regular day hospital attendance. CONCLUSION: Heart failure in frail elderly patients is often compounded by other major illnesses and polypharmacy which have a profound impact on their functional status. This has implications for the most effective targeting of evidence based treatment.
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Lien et al. (2002) conducted an observational in Heart failure (n=116). Clinical signs, chest X-rays, and abnormal ECGs had low specificities for diagnosing heart failure (50%, 20%, and 9%, respectively) in frail elderly patients with multiple comorbidities.
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