May 14, 2007Open Access

Cardiac asthma in elderly patients: incidence, clinical presentation and outcome

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Congestive heart failure (n=212). Intervention: Cardiac asthma (CHF with wheezing) vs. Classical cardiogenic pulmonary edema (CHF without wheezing). Primary outcome: One-year mortality (p=>0.05).

Key Result

Cardiac asthma in elderly patients with heart failure was associated with greater hypercapnia but resulted in similar one-year mortality (48%) compared to classical cardiogenic pulmonary edema (43%).

Study Design

Type

Observational (n=212)

Multicenter

PICO

Population

Congestive heart failure (n=212)

Intervention / Comparator

Cardiac asthma (CHF with wheezing) vs Classical cardiogenic pulmonary edema (CHF without wheezing)

Primary Outcome

One-year mortality, p=>0.05

Main Result

Absolute Event Rate: 48% vs 43%

p-value: p=>0.05

Limitations

COPD diagnosis was based on clinical approach rather than spirometry
Only one third of patients had pulmonary function tests performed
Lack of objective criteria to differentiate cardiac asthma from co-existing lung disease
Measurement of lung volumes by plethysmography was rarely performed
Low prevalence of bronchodilators given to wheezing patients in the emergency room

Abstract

BACKGROUND: Cardiac asthma is common, but has been poorly investigated. The objective was to compare the characteristics and outcome of cardiac asthma with that of classical congestive heart failure (CHF) in elderly patients. METHODS: Prospective study in an 1,800-bed teaching hospital. RESULTS: Two hundred and twelve consecutive patients aged > or = 65 years presenting with dyspnea due to CHF (mean age of 82 +/- 8 years) were included. Findings of cardiac echocardiography and natriuretic peptides levels were used to confirm CHF. Cardiac asthma patients were defined as a patient with CHF and wheezing reported by attending physician upon admission to the emergency department. The CHF group (n = 137) and the cardiac asthma group (n = 75), differed for tobacco use (34% vs. 59%, p < 0.05), history of chronic obstructive pulmonary disease (16% vs. 47%, p < 0.05), peripheral arterial disease (10% vs. 24%, p < 0.05). Patients with cardiac asthma had a significantly lower pH (7.38 +/- 0.08 vs. 7.43 +/- 0.06, p < 0.05), and a higher PaCO2 (47 +/- 15 vs. 41 +/- 11 mmHg, p < 0.05) at admission. In the cardiac asthma group, patients had greater distal airway obstruction: forced expiratory volume in 1 second of 1.09 vs. 1.33 Liter (p < 0.05), and a forced expiratory flow at 25% to 75% of vital capacity of 0.76 vs. 0.99 Liter (p < 0.05). The in-hospital (23% vs. 19%) and one year mortality (48% vs. 43%) rates were similar. CONCLUSION: Patients with cardiac asthma represented one third of CHF in elderly patients. They were more hypercapnic and experienced more distal airway obstruction. However, outcomes were similar.

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