24-Hour Holter Monitoring for Identification of Arrhythmias in Elderly Heart Failure Patients: A Single-Centre Study.

Introduction Chronic heart failure (CHF) is a common condition seen in the elderly, and unlike coronary artery disease (CAD), its prevalence increases with age. Electrocardiography (ECG) at rest is a simple, non-invasive investigation that is recommended in the initial evaluation of patients with heart failure. The purpose of this study was to identify various ECG abnormalities in elderly patients with heart failure and to find out whether Holter monitoring increases the chances of identifying arrhythmia in them. Materials and methods The current study was a single-centre, cross-sectional observational study. The study was conducted by collecting data from patients with heart failure attending the medicine and cardiology departments of All India Institute of Medical Sciences, Rishikesh, a tertiary care facility, from May 1st, 2020, to October 31st, 2021. The goal of this study was to look for electrocardiographic abnormalities in elderly heart failure patients who had a reduced (<50%) or preserved (>=50%) left ventricular ejection fraction (LVEF). All consecutively admitted patients who fulfilled the inclusion criteria were enrolled in the study after taking informed consent. All patients underwent echocardiography, electrocardiography and Holter monitoring. Demographic parameters were collected on a pre-formed proforma, and data was entered into an Excel sheet. Results A total of 101 patients were analyzed, and abnormal ECG results were found in 98% of them. Out of 101 patients, 80 (79.2%) patients had heart failure with reduced ejection fraction (HFrEF), with LVEF < 50%, and 21 (20.8%) patients had heart failure with preserved ejection fraction (HFpEF), with LVEF >=50%. Hypertensive heart disease was the most common etiological factor attributing to heart failure in 37 (36.6%) patients and more among heart failure with reduced EF (p=0.01) followed by ischemic heart disease. Old ischemic changes were the commonest ECG abnormality, found in 48 (47.53%) patients with heart failure and among 45 patients (56.25%) with HFrEF (p=<0.001 ). Atrial fibrillation was the most common arrhythmia, occurring in 25 (24.75%) patients with heart failure. The detection rate of arrhythmia by Holter was better than surface ECG in patients with HErEF (p=0.007). Conclusion Electrocardiogram (ECG) in elderly heart failure patients is almost always abnormal. The majority of the patients in our study had more than two ECG abnormalities. ECG is a simple non-invasive tool that can detect underlying etiological factors attributing to heart failure. Holter monitoring can be done as an additional modality to detect arrhythmias in heart patients with reduced ejection fraction for risk stratification.