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Prevalence of left ventricular systolic dysfunction and heart failure in high risk patients: community based epidemiological study

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7373.1156 (Published 16 November 2002) Cite this as: BMJ 2002;325:1156
  1. R C Davis, clinical research fellow (R.C.Davis{at}bham.ac.uk)a,
  2. F D R Hobbs, professor of primary care and general practicea,
  3. J E Kenkre, senior research fellowa,
  4. A K Roalfe, statisticiana,
  5. R Hare, research associatea,
  6. R J Lancashire, computer officerb,
  7. M K Davies, consultant cardiologistc
  1. aDepartment of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT
  2. bDepartment of Public Health and Epidemiology, University of Birmingham
  3. cDepartment of Cardiology, Selly Oak Hospital, Birmingham
  1. Correspondence to: R C Davis, Sandwell General Hospital, Lyndon, West Bromwich B71 4HJ
  • Accepted 15 August 2002

abstract

Objectives: To determine the prevalence of left ventricular systolic dysfunction, and of heart failure due to different causes, in patients with risk factors for these conditions.

Design: Epidemiological study, including detailed clinical assessment, electrocardiography, and echocardiography.

Setting: 16 English general practices, representative for socioeconomic status and practice type.

Participants: 1062 patients (66% response rate) with previous myocardial infarction, angina, hypertension, or diabetes.

Main outcome measures: Prevalence of systolic dysfunction, both with and without symptoms, and of heart failure, in groups of patients with each of the risk factors.

Results: Definite systolic dysfunction (ejection fraction <40%) was found in 54/244 (22.1%, 95% confidence interval 17.1% to 27.9%) patients with previous myocardial infarction, 26/321 (8.1%, 5.4% to 11.6%) with angina, 7/388 (1.8%, 0.7% to 3.7%) with hypertension, and 12/208 (5.8%, 3.0% to 9.9%) with diabetes. In each group, approximately half of these patients had symptoms of dyspnoea, and therefore had heart failure. Overall rates of heart failure, defined as symptoms of dyspnoea plus objective evidence of cardiac dysfunction (systolic dysfunction, atrial fibrillation, or clinically significant valve disease) were 16.0% (11.6% to 21.2%) in patients with previous myocardial infarction, 8.4% (5.6% to 12.0%) in those with angina, 2.8% (1.4% to 5.0%) in those with hypertension, and 7.7% (4.5% to 12.2%) in those with diabetes.

Conclusion: Many people with ischaemic heart disease or diabetes have systolic dysfunction or heart failure. The data support the need for trials of targeted echocardiographic screening, in view of the major benefits of modern treatment. In contrast, patients with uncomplicated hypertension have similar rates to the general population.

Footnotes

  • Funding NHS research and development cardiovascular disease and stroke programme.

  • Competing interests FDRH is a member of the European Society of Cardiology working party on heart failure, chair of the British Primary Care Cardiovascular Society, and Treasurer of the British Society for Heart Failure. MKD is chairman of the British Society for Heart Failure. FDRH and MKD have received travel sponsorship and honorariums from several biotechnology and pharmaceutical companies with cardiovascular products for plenary talks and attendance at major cardiology scientific congresses and conferences.

  • Accepted 15 August 2002
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