title: Clinical syndrome suggestive of heart failure is frequently attributable to non-cardiac disorders--population-based study.
abstract: OBJECTIVE
  To assess how often the clinical syndrome (CS) of heart failure is attributable to alternative, including non-cardiac, explanations.
  
  
  RESULTS
  Cross-sectional evaluation of 739 community participants aged>or=45 years. Subjects with >or=2 symptoms or signs (dyspnoea or fatigue, orthopnoea, nocturnal paroxysmal dyspnoea, third heart sound, jugular venous distension, rales and lower limb oedema) or who were receiving loop diuretics were considered to have the clinical syndrome of heart failure. Attributable fractions were derived based on adjusted odds ratios and the prevalence of underlying disorders among cases. CS was present in 28.0% of women and in 15.2% of men, p<0.001. The multivariate-adjusted fraction of CS attributable to female gender was 40.6%, to age>or=65 years 28.5%, left ventricular systolic dysfunction, left ventricular dilatation or moderate-severe valvular disease 4.9%, diastolic dysfunction or atrial fibrillation 13.0%, obesity 22.6%, coronary heart disease 7.2% and chronic lung disease 6.9%. When additionally adjusting for depressive symptoms, the association with gender and age became much weaker, and 32% of cases were attributable to depressive symptoms. Forty-two percent of subjects with CS had cardiac abnormalities.
  
  
  CONCLUSIONS
  In less than half of subjects with CS was systolic or diastolic heart failure confirmed. Female gender, older age, obesity and depressive symptoms accounted for the largest fraction of CS.
authors.affiliation: Department of Hygiene and Epidemiology, University of Porto Medical School, and Heart Failure Clinic, Department of Internal Medicine, Hospital S. João, Porto, Portugal. anazev@med.up.pt
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
authors.forename: Joana
authors.initials: J
authors.lastname: Pimenta
authors.forename: Fernando
authors.initials: F
authors.lastname: Friões
authors.forename: Cassiano
authors.initials: C
authors.lastname: Abreu-Lima
authors.forename: Hans-Werner
authors.initials: HW
authors.lastname: Hense
authors.forename: Henrique
authors.initials: H
authors.lastname: Barros
mesh_terms: D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D003971:Diastole; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013577:Syndrome; D013599:Systole