Heart failure in patients seeking medical help at outpatients clinics. Part I. General characteristics.

Background: During the last decade, the beneficial changes in lifestyle and in medical care increased average life expectancy, particularly in patients with chronic diseases such as hypertension and coronary heart disease. Unfortunately this also increased the number of patients, particularly among the elderly, who are susceptible to complications of these conditions such as heart failure. Uncontrolled hypertension is known to be a primary cause of heart failure and is also known to be very prevalent and frequently uncontrolled in the Polish population.

Aim: To estimate the prevalence and characteristics of heart failure among patients of 65 years and older seeking medical care in outpatient clinics in Poland.

Methods: The study is a cross-country epidemiological project in which 417 physicians from outpatient clinics were asked to register 50 consecutive patients aged 65 years and above seeking medical care for any cause. Information on case history, physical examination (diagnosis of heart failure, NYHA class, heart failure symptoms), laboratory tests (resting ECG, chest X-ray, echocardiogram) and data concerning pharmacology management during the 2 weeks prior to the index visit was obtained.

Results: Over 5 months, 19877 eligible patients (7324 men and 12553 women) presented to the 417 participating physicians (90% physicians registered 46-50 patients). Among the patients, 53% were diagnosed with heart failure (3901 men and 6678 women), prevalence did not differ by gender. Among patients with heart failure there were 38% of men in NYHA class III or IV and 34% of women. Coronary heart disease was a predominant cause of heart failure in 87% of men (26% of cases with isolated coronary heart disease, 53% with concomitant hypertension and 8% with other diseases), while percentages for women were 80% (15%, 61% and 4%, respectively). Isolated hypertension was a further cause of heart failure in 8% of men and 13% of women. Cardiac arrhythmia was found in approximately 20% of patients, enlargement of heart size in 32% of patients and peripheral leg edema in 54% of men and 64% of women. These symptoms increased with age. Chest X-ray revealed cardiomegaly in 68% of men and women and increased cardiothoracic ratio (>50%) in approximately 40% of patients. From resting ECGs, cardiac arrhythmia was recorded in 21% of patients with heart failure, with atrial fibrillation as a predominant disorder (19%). Left ventricular hypertrophy on resting ECG was noted in 42% of men and women and old myocardial infarction or cardiac ischemia was diagnosed in 71% of men and 66% of women.

Conclusions: (1) Heart failure was diagnosed in over half of outpatients aged 65 and older; in more than a third of these it was NYHA class III and IV. (2) Outpatients with heart failure had a high frequency of co-existing diseases such as arrhythmia, coronary heart disease and hypertension.