title: Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion.
abstract: OBJECTIVE
  The majority of patients with heart failure are diagnosed in primary care, but underdiagnosis is common. Shortness of breath is a prevalent complaint of older persons and one of the key symptoms of heart failure. We assessed the prevalence of unrecognized heart failure in elderly patients presenting to primary care with shortness of breath on exertion.
  
  
  RESULTS
  This was a cross-sectional selective screening study. Patients aged 65 years or over presenting to primary care with shortness of breath on exertion in the previous 12 months were eligible when not known to have an established, echocardiographic confirmed diagnosis of heart failure. All participants underwent history taking, physical examination, electrocardiography, and a blood test of N-terminal pro B-type natriuretic peptide (NTproBNP). Only those with an abnormal electrocardiogram or NTproBNP level exceeding the exclusionary cut-point for non-acute onset heart failure (>15 pmol/L (≈125 pg/mL) underwent open-access echocardiography. An expert panel established presence or absence of heart failure according to the criteria of the European Society of Cardiology heart failure guidelines. The mean age of the 585 participants was 74.1 (SD 6.3) years, and 54.5% were female. In total, 92 (15.7%, 95% CI 12.9-19.0) participants had heart failure: 17 (2.9%, 95% CI 1.8-4.7) had heart failure with a reduced ejection fraction (≤45%), 70 (12.0%, 95% CI 9.5-14.9) had heart failure with preserved ejection fraction, and five (0.9%, 95% CI 0.3-2.1) had isolated right-sided heart failure.
  
  
  CONCLUSIONS
  Elderly primary care patients with shortness of breath on exertion often have unrecognized heart failure, mainly with preserved ejection fraction.
authors.affiliation: Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, PO Box 85500, 3508 AB, Utrecht, the Netherlands.
authors.forename: Evelien E S
authors.initials: EE
authors.lastname: van Riet
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.forename: Alexander
authors.initials: A
authors.lastname: Limburg
authors.forename: Marcel A J
authors.initials: MA
authors.lastname: Landman
authors.forename: Henk
authors.initials: H
authors.lastname: van der Hoeven
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004417:Dyspnea / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D005082:Physical Exertion; D011320:Primary Health Care; D013318:Stroke Volume
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Diagnosis; Echocardiography; Elderly; Heart failure; Prevalence; Primary care