Di Bari M, Marchionni N, Ferrucci L, Pini R, Antonini E, Chiarlone M, Marsilii A, De Alfieri W, Fumagalli S, Masotti G
Department of Gerontology and Geriatrics, University of Florence, Italy.
J Am Geriatr Soc. 1999 Jun;47(6):664-71. doi: 10.1111/j.1532-5415.1999.tb01587.x.
The prevalence of heart failure (HF) increases with age, and HF is a major cause of disability and mortality in older persons. Detection of HF in epidemiological studies has relied on criteria validated only in young and middle-age adults, and, therefore, may prove inadequate in older subjects, because they do not take into account the pathophysiologic and clinical peculiarities of HF in old age. Thus, the true prevalence of HF in the older general population remains uncertain and has probably been underestimated in previous studies. Moreover, the mechanism and the extent by which HF hinders physical functioning in older people has not been fully elucidated.
This paper describes the design of the ICARe study, carried out in an older home-dwelling population to collect data about: (1) the sensitivity and specificity of diagnostic criteria used previously in epidemiological studies of HF; (2) the prevalence of the different pathophysiologic forms of HF; and (3) the impact of HF on overall health status, and on physical functioning, in the absence or presence of chronic comorbidity.
This was a cross-sectional survey. Eligible were all community-dwelling persons aged 65 years or older recorded in the Registry Office of Dicomano, a small town nearby Florence (Italy). All the domains of multidimensional geriatric assessment were explored through different phases of the study (home interview, laboratory testing, geriatric visit) that comprised an extensive cardiopulmonary instrumental assessment including: color Doppler echocardiography, echotomography of the carotid arteries used in an original method to determine arterial compliance, and bell spirometry. Presence of major chronic conditions was ascertained by predefined, standard algorithms that were based largely on clinical examination.
There were 864 older persons eligible for the ICARe study. Even with a substantial decline from home interview (91.2%) to the cardiopulmonary study (71.1%), the adherence rate remained high throughout the study, and the population examined was fairly representative of the original eligible population. Thus, we believe that the data collected in this study offer a unique opportunity to assess the validity of the diagnostic clinical criteria for HF in the general older population, to identify the pathophysiology underlying the syndrome, and to investigate the relationship between HF, comorbidity, and disability.
心力衰竭（HF）的患病率随年龄增长而增加，并且HF是老年人残疾和死亡的主要原因。在流行病学研究中，HF的检测依赖于仅在年轻和中年成年人中验证过的标准，因此，这些标准在老年受试者中可能并不适用，因为它们没有考虑到老年HF的病理生理和临床特点。因此，老年普通人群中HF的真实患病率仍然不确定，并且在先前的研究中可能被低估了。此外，HF阻碍老年人身体功能的机制和程度尚未完全阐明。
本文描述了ICARe研究的设计，该研究在居家老年人群中开展，以收集有关以下方面的数据：（1）先前在HF流行病学研究中使用的诊断标准的敏感性和特异性；（2）不同病理生理形式的HF的患病率；（3）在有无慢性合并症的情况下，HF对总体健康状况和身体功能的影响。
这是一项横断面调查。符合条件的是在意大利佛罗伦萨附近的小镇迪科马诺户籍登记处登记的所有65岁及以上的社区居民。通过研究的不同阶段（家庭访谈、实验室检测、老年医学门诊）探索多维老年医学评估的所有领域，其中包括广泛的心肺器械评估，包括：彩色多普勒超声心动图、采用一种原始方法用于确定动脉顺应性的颈动脉超声断层扫描以及钟形肺活量测定法。主要慢性病的存在通过主要基于临床检查的预定义标准算法来确定。
有864名老年人符合ICARe研究的条件。即使从家庭访谈（91.2%）到心肺研究（71.1%）大幅下降，整个研究过程中的依从率仍然很高，并且所检查的人群相当能代表最初符合条件的人群。因此，我们认为本研究收集的数据提供了一个独特的机会，可用于评估老年普通人群中HF诊断临床标准的有效性，确定该综合征的潜在病理生理学，并研究HF、合并症和残疾之间的关系。
