BMJ 1999;318:368-372 ( 6 February )

General Practice

Prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in general practice setting: cross sectional survey

S Morgan, Wellcome Trust research fellow, a H Smith, senior lecturer, a I Simpson, consultant cardiologist, b G S Liddiard, general practitioner, d H Raphael, research nurse, a R M Pickering, lecturer, c D Mant, professor. a

a Primary Medical Care, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, b Wessex Cardiothoracic Centre, Southampton General Hospital, Southampton SO16 6YD, c Medical Statistics and Computing, University of Southampton, Southampton General Hospital, d The Adam Practice, Upton Health Centre, Poole, Dorset H15 2HX

Objective: To assess the prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in the general practice setting by echocardiographic assessment of ventricular function.
Design: Cross sectional survey.
Setting: Four centre general practice in Poole, Dorset.
Subjects: 817 elderly patients aged 70-84 years.
Main outcomes: Echocardiographic assessment of left ventricular systolic function including measurement of ejection fraction by biplane summation method where possible, clinical symptoms, and signs of left ventricular dysfunction.
Results: The overall prevalence of left ventricular systolic dysfunction was 7.5% (95% confidence interval 5.8% to 9.5%); mild dysfunction (5.0%) was considerably more prevalent than moderate (1.6%) or severe dysfunction (0.7%). Measurement of ejection fraction was possible in 82% of patients (n=667): in patients categorised as having mild, moderate, or severe dysfunction, the mean ejection fraction was 48% (SD 12.0), 38% (8.1), and 26% (7.9) respectively. At all ages the prevalence was much higher in men than in women (odds ratio 5.1, 95% confidence interval 2.6 to 10.1). No clinical symptom or sign was both sensitive and specific. In around half the patients with ventricular dysfunction (52%, 32/61) heart failure had not been previously diagnosed.
Conclusions: Unrecognised left ventricular dysfunction is a common problem in elderly patients in the general practice setting. Appropriate treatment with angiotensin converting enzyme inhibitors has the potential to reduce hospitalisation and mortality in these patients, but diagnosis should not be based on clinical history and examination alone. Screening is feasible in general practice, but it should not be implemented until the optimum method of identifying left ventricular dysfunction is clarified, and the cost effectiveness of screening has been shown.


Key messages

  • Left ventricular dysfunction detected by echocardiography is common in elderly people

  • Men are much more likely to be affected than women

  • The accuracy of clinical diagnosis is very limited in this age group

  • Many patients who would benefit from treatment remain undetected




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Rapid Responses:

Read all Rapid Responses

Electrocardiograms should have been performed in this cross sectional survey.
S Talwar
bmj.com, 13 Feb 1999 [Full text]
Echocardiography should be encouraged in the elderly
Syed Zaman
bmj.com, 15 Feb 1999 [Full text]
Data on LV hypertrophy avalable?
Stuart Hutcheon
bmj.com, 16 Mar 1999 [Full text]
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