Durham Clinical Trials Unit, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees TS17 6BH, UK.
Eur J Heart Fail. 2013 Feb;15(2):158-65. doi: 10.1093/eurjhf/hfs165. Epub 2012 Oct 30.
Diagnosis of heart failure in older people in long-term care is challenging because of co-morbidities, cognitive deficit, polypharmacy, immobility, and poor access to services. This study aimed to ascertain heart failure prevalence and clinical management in this population.
A total of 405 residents, aged 65-100 years, in 33 UK care facilities were prospectively enrolled between April 2009 and June 2010. The presence of heart failure was determined using European Society of Cardiology guidelines, modified where necessary for immobility. Evaluation of symptoms and signs, functional capacity, and quality of life, portable on-site echocardiography, and medical record review were completed in 399 cases. The point prevalence of heart failure was 22.8% [n = 91, 95% confidence interval (CI) 18.8-27.2%]; of these, 62.7% (n = 57, 95% CI 59.6-66.5%) had heart failure with preserved ejection fraction and 37.3% had left ventricular systolic dysfunction (n = 34, 95% CI 34.8-40.5%). A total of 76% (n = 61) of previous diagnoses of heart failure were not confirmed, and up to 90% (n = 82) of study cases were new. No symptoms or signs were reliable predictors of heart failure.
Heart failure was diagnosed in almost a quarter of residents: the prevalence was substantially higher than in other populations. The majority of heart failure cases were undiagnosed, while three-quarters of previously recorded cases were misdiagnosed. Common symptoms and signs appear to have little clinical utility in this population. Early, accurate differential diagnosis is key to the effective management of heart failure; this may be failing in long-term care facilities.
老年人在长期护理中出现心力衰竭的诊断具有挑战性，这是由于合并症、认知障碍、多种药物治疗、活动受限以及服务获取受限等因素导致的。本研究旨在确定该人群中心力衰竭的患病率和临床管理情况。
2009 年 4 月至 2010 年 6 月期间，共前瞻性纳入了 33 家英国护理机构中 405 名年龄在 65-100 岁的居民。采用欧洲心脏病学会指南确定心力衰竭的存在，如有必要，可根据活动受限情况进行修改。在 399 例病例中完成了症状和体征、功能能力和生活质量评估、便携式现场超声心动图检查以及病历审查。心力衰竭的时点患病率为 22.8%[n=91，95%置信区间（CI）18.8-27.2%]；其中，62.7%（n=57，95%CI 59.6-66.5%）为射血分数保留的心力衰竭，37.3%（n=34，95%CI 34.8-40.5%）为左心室收缩功能障碍。之前诊断为心力衰竭的病例中，有 76%（n=61）未得到确认，高达 90%（n=82）的病例为新诊断病例。没有症状或体征是心力衰竭的可靠预测指标。
近四分之一的居民被诊断为心力衰竭：其患病率明显高于其他人群。大多数心力衰竭病例未被诊断，而之前记录的病例中有四分之三被误诊。常见的症状和体征在该人群中似乎没有多少临床应用价值。早期、准确的鉴别诊断是心力衰竭有效管理的关键，但在长期护理机构中可能存在这种诊断不足的情况。
