Symptoms associated with an abnormal echocardiogram in elderly primary care hypertension patients

BACKGROUND: The prevalence and diagnostic value of heart failure symptoms in elderly primary care patients with hypertension is unknown. AIM: To assess the prevalence, sensitivity, specificity, positive and negative predictive value of symptoms in association with an abnormal echocardiogram. DESIGN AND SETTING: Cross-sectional screening study in five general practices in the south-east of the Netherlands. METHOD: Between June 2010 and January 2013, 591 primary care hypertension patients aged between 60 and 85 years were included, without known heart failure and not treated by a cardiologist. All patients underwent an echocardiogram and a structured interview including assessment of heart failure symptoms: shortness of breath, fatigue, oedema, cold extremities, and restless sleep. RESULTS AND CONCLUSION: Restless sleep was reported by 25 %, cold extremities by 23 %, fatigue by 19 %, shortness of breath by 17 %, and oedema by 13 %. Oedema was the only symptom significantly associated with an abnormal echocardiogram (positive predictive value was 45 %, sensitivity 20 %, and specificity 90 %, OR 2.12; 95 % CI = 1.23-3.64), apart from higher age (OR 1.06; 95 % CI = 1.03-1.09), previous myocardial infarction (OR 3.00; 95 % CI = 1.28-7.03), and a systolic blood pressure of >160 mmHg (OR 1.62; 95 % CI = 1.08-2.41). Screening with echocardiography might be considered in patients with oedema.