Community prevalence of left ventricular dysfunction and atrial fibrillation, and impact on quality of life
Davis RC., Hobbs FDR., Kenkre JE., Roalfe AK., Davies MK.
Heart failure is common and causes high mortality and morbidity. ACE inhibitors significantly improve prognosis in left ventricular (LV) systolic dysfunction, so accurate diagnosis is important Atrial fibrillation (AF) is also common and anticoagulation reduces embolic stroke risk Prevalence data will help identify those at highest risk with a view to screening Little is known of overall quality of life in cardiac conditions Methods: The prevalence of LV systolic dysfunction & AF was assessed in the community, in 3960 patients aged 45+ (63% response). All had clinical history & examination, ECG, echocardiography, and the SF-36 health status questionnaire Further cohorts of 782 with a diagnosis of heart failure, 928 on diuretics, and 1062 with risk factors (MI, angina, hypertension, diabetes) were assessed similarly Results: The prevalence of significant left ventricular dysfunction (ejection fraction (EF) < 40%) was 1 8%, 3.5% had borderline LV function (EF 40-50%) Prevalence of EF < 40% increased from 0.3% in 45-54 year olds to 3 7% at 75-84 years 99% of the patients had some ECG abnormality 47% of those with EF < 40% were asymptomatic 32% of those with symptomatic LV dysfunction took ACE inhibitors Only 22% of patients with a previous clinical diagnosis of heart failure had EF < 40% 18% had evidence of valvular disease and 22 5% were in AF, half of those in AF had EF > 50%. Less than 10% of patients on diuretics had EF < 40% 22% of those in the community with a previous MI had EF < 40%, with EF 40-50% in a further 20%, 8.1% of patients with angina, 6.3% of diabetics and 1.8% of hypertensives had EF < 40%. The prevalence of AF in the general population was 20%, prevalence rising with age to 8% over the age of 75 About 5% of patients with ischaemic heart disease, hypertension or diabetes had concomitant AF Patients with heart failure had significant impairment of all measured areas of health All modalities of health were affected in ordered sequence with NYHA class Those with asymptomatic LV dysfunction had similar health perceptions to the random population sample Those with heart failure had more impairment of all the measured areas of health, except pain, than those with other cardiovascular conditions Conclusions: LV dysfunction is found frequently in those with ischaemic heart disease and AF is very common in the elderly Screening such patients would yield many candidates for treatment Heart failure has great impact on overall quality of life. The rapidly-assessed NYHA class of patients was a good predictor of patients' overall quality of life.