Underestimated Prevalence of Chronic Heart Failure among the Elderly Residing in Care Homes in Aruba.

Objective: Diagnosing chronic heart failure (CHF) is important, since subsequent treatments by medication and cardiac intervention improve quality of life. However, accurate CHF diagnosis in the elderly residing in care homes (residents) is hampered by suboptimal diagnostic tools, co-morbidity and physician's unawareness of CHF. We sought to estimate the CHF prevalence among Aruban residents.

Methods: All eligible residents were clinically assessed and screened for CHF signs and symptoms. The diagnosis of CHF was made by final judgment of a cardiologist. Plasma B-type-natriuretic peptide (BNP) levels were determined.

Results: Of the 235 residents, 184 (78%) were excluded, mostly because of decreased cognition. The remaining 51 included residents with a mean age of 78 ± 8 years; 57% was female, 59% had diabetes mellitus Type 2 and 71% had renal dysfunction (< 60 mL/min/1.73 m2). Sixteen (31%) had CHF, of which five (31%) were aware of their diagnosis and 11 (69%) were being diagnosed for the first time. Two (29%) residents were previously incorrectly diagnosed with CHF. Most residents with CHF (94%) also had renal dysfunction and 75% had diabetes mellitus Type 2. At a BNP cut-off value of 100 pg/mL, the sensitivity, specificity and predictive values of positive and negative tests were 0.75, 0.69, 0.52 and 0.86, respectively.

Conclusion: The CHF prevalence in Aruba residents is high (31%) and underestimated. The high CHF prevalence may be related to the high occurrence of diabetes mellitus Type 2 in Arubans. The use of BNP at a cut-off value of 100 pg/mL adds value to the diagnostic work-up of CHF in the elderly residing in care homes.