Heart Failure and Vascular Risk Unit, Internal Medicine Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
Eur J Heart Fail. 2012 Oct;14(10):1097-103. doi: 10.1093/eurjhf/hfs109. Epub 2012 Jul 6.
The prevalence and mortality of heart failure (HF) increase with age. As a result, the early diagnosis of HF in this population is useful to reduce cardiovascular morbidity and probably mortality. However, the diagnosis of HF in the elderly is a challenge. These challenges arise from the under-representation of elderly patients in diagnostic studies and clinical trials, the increasing prevalence of HF with relatively normal ejection fraction, the difficulty in accurate diagnosis, the underuse of diagnostic tests, and the presence of co-morbidities. Particularly in the elderly, symptoms and signs of HF may be atypical and can be simulated or disguised by co-morbidities such as respiratory disease, obesity, and venous insufficiency. This review aims to provide a practical clinical approach for the diagnosis of older patients with HF based on the scarce available evidence and our clinical experience. Therefore, it should be interpreted in many aspects as an opinion paper with practical implications. The most useful clinical symptoms are orthopnoea and paroxysmal nocturnal dyspnoea. However, confirmation of the diagnosis always requires further tests. Although natriuretic peptides accurately exclude cardiac dysfunction as a cause of symptoms, the optimal cut-off level for ruling out HF in elderly patients with other co-morbidities is still not clear. In our opinion, echocardiography should be performed in all elderly patients to confirm the diagnosis of HF, except in those cases with low clinical probability and a concentration of brain natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) lower than 100 or 400 pg/mL, respectively.
心力衰竭（HF）的患病率和死亡率随年龄增长而增加。因此，早期诊断老年人 HF 有助于降低心血管发病率，可能也有助于降低死亡率。然而，老年人 HF 的诊断颇具挑战。这些挑战源于：在诊断研究和临床试验中，老年人患者代表性不足；射血分数相对正常的 HF 患病率不断增加；准确诊断困难；诊断性检查使用不足；并存疾病。尤其是老年人，HF 的症状和体征可能不典型，并存疾病如呼吸系统疾病、肥胖和静脉功能不全可能模拟或掩盖这些症状和体征。本文旨在根据有限的现有证据和我们的临床经验，为老年 HF 患者的诊断提供实用的临床方法。因此，应从多方面将其理解为具有实际意义的观点性论文。最有用的临床症状是端坐呼吸和夜间阵发性呼吸困难。然而，要确诊 HF，始终需要进一步检查。虽然利钠肽可准确排除心功能障碍引起的症状，但仍不清楚在有其他并存疾病的老年患者中，用于排除 HF 的最佳截断值。我们认为，除临床可能性低且脑利钠肽（BNP）或 N 末端脑利钠肽前体（NT-proBNP）浓度分别低于 100 或 400 pg/ml 的患者外，所有老年患者均应行超声心动图以确认 HF 诊断。
