Left ventricular systolic dysfunction and atrial fibrillation in older people in the community--a need for screening?
BACKGROUND
Heart failure and stroke are major causes of morbidity and mortality in older people. Angiotensin converting enzyme inhibitors improve symptoms and survival in left ventricular systolic dysfunction. Anticoagulants are effective in stroke prevention in atrial fibrillation with aspirin being a less effective alternative.


OBJECTIVE
To determine the prevalence of left ventricular systolic dysfunction, health services utilisation and prescribing of diuretics and angiotensin converting enzyme inhibitors in left ventricular systolic dysfunction, and the prevalence of atrial fibrillation and anti-platelet/thrombotic therapy in atrial fibrillation in older people in the community.


METHODS
500 subjects were drawn by two-stage random sampling from 5,002 subjects aged 70 years and over living at home. Subjects were screened for atrial fibrillation and left ventricular systolic dysfunction using electrocardiography and echocardiography.


RESULTS
The population prevalence amongst older people of left ventricular systolic dysfunction was 9.8% and of atrial fibrillation 7.8%. More than two-thirds of those with left ventricular systolic dysfunction were not on angiotensin converting enzyme inhibitors. Of those in atrial fibrillation, 35% were taking aspirin, 24% were taking warfarin and 41% were on neither aspirin nor warfarin. Nearly 90% of older people in the community have had contact with their general practitioner over the past year, and over half of those with left ventricular systolic dysfunction have had contact with hospital-based services over the past 2 years.


CONCLUSIONS
Left ventricular systolic dysfunction is under-treated in older people in the community. Despite the high level of contact with hospital and community-based services, the majority of those with systolic left ventricular dysfunction are not on angiotensin converting enzyme inhibitors and a significant proportion of those in atrial fibrillation are not on any treatment for stroke prevention.
University Department of Geriatric Medicine, Llandough Hospital, Cardiff, UK.
Shu F
SF
Ho
M Sinead
MS
O'Mahony
John A
JA
Steward
Michael L
ML
Burr
Maurice
M
Buchalter
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology*; D003153:Community Health Services / Q000706:statistics & numerical data; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D004417:Dyspnea / Q000453:epidemiology / Q000209:etiology; D004452:Echocardiography / Q000187:drug effects; D004562:Electrocardiography / Q000187:drug effects; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000453:epidemiology*; D014852:Wales / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D014859:Warfarin; D001241:Aspirin