Unrecognized heart failure and chronic obstructive pulmonary disease (COPD) in frail elderly detected through a near-home targeted screening strategy.
BACKGROUND
Reduced exercise tolerance and dyspnea are common in older people, and heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the main causes. We want to determine the prevalence of previously unrecognized HF, COPD, and other chronic diseases in frail older people using a near-home targeted screening strategy.


METHODS
Community-dwelling frail persons aged ≥65 years underwent a 2-step screening strategy. First, they received a questionnaire inquiring about dyspnea and exercise tolerance. Those with exercise intolerance and/or dyspnea were invited to visit their primary care physician's office for a screening program, including medical history taking, physical examination, blood tests, electrocardiography, spirometry, and echocardiography. The final diagnosis of every patient was determined by a panel consisting of 3 physicians.


RESULTS
Of the 570 elderly who filled out the questionnaire, 395 (69%) had reduced exercise tolerance or dyspnea. Of these, 389 underwent the screening program: 127 (33.5%, 95% confidence interval, 28.9-38.4%) were newly diagnosed with HF (mainly HF with a preserved ejection fraction [23.5%]), and previously unrecognized COPD was detected in 16.8% (95% confidence interval, 13.4-20.9%). In total, 165 patients (43.9%) received a new diagnosis of either HF, COPD, or both. Other new diagnoses (in 32.7% of the screening program patients) included atrial fibrillation (1.8%), valvular disease (21.4%), (persisting) asthma (3.1%), anemia (12.7%), and thyroid disease (0.6%). No clear explanation for the complaints of 47 patients (12.2%) was found using our strategy.


CONCLUSIONS
Unrecognized chronic diseases might be detected in community-dwelling frail elderly using a near-home screening strategy that is simple to implement. It remains to be proven, however, whether optimizing treatment of the newly detected diagnoses in this fragile population with multimorbidities and polypharmacy improves quality of life and reduces morbidity and mortality.
From the Julius Center for Health Sciences and Primary care (YvM, JBR, KGMM, AWH, FHR), the Department of Cardiology, Heart Lung Center (MJMC), and the Department of Respiratory Medicine (J-WJL), University Medical Center Utrecht, Utrecht, the Netherlands. Y.vanMourik@umcutrecht.nl.
Yvonne
Y
van Mourik
From the Julius Center for Health Sciences and Primary care (YvM, JBR, KGMM, AWH, FHR), the Department of Cardiology, Heart Lung Center (MJMC), and the Department of Respiratory Medicine (J-WJL), University Medical Center Utrecht, Utrecht, the Netherlands.
Loes C M
LC
Bertens
From the Julius Center for Health Sciences and Primary care (YvM, JBR, KGMM, AWH, FHR), the Department of Cardiology, Heart Lung Center (MJMC), and the Department of Respiratory Medicine (J-WJL), University Medical Center Utrecht, Utrecht, the Netherlands.
Maarten J M
MJ
Cramer
From the Julius Center for Health Sciences and Primary care (YvM, JBR, KGMM, AWH, FHR), the Department of Cardiology, Heart Lung Center (MJMC), and the Department of Respiratory Medicine (J-WJL), University Medical Center Utrecht, Utrecht, the Netherlands.
Jan-Willem J
JW
Lammers
From the Julius Center for Health Sciences and Primary care (YvM, JBR, KGMM, AWH, FHR), the Department of Cardiology, Heart Lung Center (MJMC), and the Department of Respiratory Medicine (J-WJL), University Medical Center Utrecht, Utrecht, the Netherlands.
Johannes B
JB
Reitsma
From the Julius Center for Health Sciences and Primary care (YvM, JBR, KGMM, AWH, FHR), the Department of Cardiology, Heart Lung Center (MJMC), and the Department of Respiratory Medicine (J-WJL), University Medical Center Utrecht, Utrecht, the Netherlands.
Karel G M
KG
Moons
From the Julius Center for Health Sciences and Primary care (YvM, JBR, KGMM, AWH, FHR), the Department of Cardiology, Heart Lung Center (MJMC), and the Department of Respiratory Medicine (J-WJL), University Medical Center Utrecht, Utrecht, the Netherlands.
Arno W
AW
Hoes
From the Julius Center for Health Sciences and Primary care (YvM, JBR, KGMM, AWH, FHR), the Department of Cardiology, Heart Lung Center (MJMC), and the Department of Respiratory Medicine (J-WJL), University Medical Center Utrecht, Utrecht, the Netherlands.
Frans H
FH
Rutten
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires
COPD; Cardiovascular Abnormalities; Dyspnea; Exercise Tolerance; Frail Elderly; Heart Failure; Respiratory Tract Diseases