Heart failure underdiagnosed in UK primary care

August 09, 2001

N.B. Please note that if you are outside North America, the embargo for lancet Press material is 0001 hours UK time Friday 10th August 2001.

A UK study published in this week's issue of THE LANCET suggests that heart failure is more common than previously thought. New strategies involving the assessment of left-ventricular function in patients with suspected heart failure could lead to more successful treatment.

An estimated 120,000 patients are admitted to hospital every year in the UK with heart disease. The disorder can be effectively treated if accurately diagnosed; however, accurate data for prevalence rates for heart failure due to various causes, and for left-ventricular systolic dysfunction (LVSD) in all adults are unavailable. Richard Hobbs and colleagues from the University of Birmingham, UK, did a population study to assess prevalence of LVSD and heart failure in a large representative adult population in England.

3960 adults aged 45 years or older from 16 general practices took part in the study. Patients were assessed by history and examination, electrocardiography, and echocardiography. Prevalence of LVSD (defined as ejection fraction of less than 40%) and heart failure was calculated.

LVSD was diagnosed in 72 (1.8%) of patients, of whom 34 patients had no symptoms. Borderline LVSD (ejection fraction 40-50%) was seen in 139 patients (3.5%). Definite heart failure was seen in 92 (2.3%), and was associated with an ejection fraction of less than 40% in 38 (41%) patients, atrial fibrillation in 30 (33%), and heart-valve disease in 24 (26%). Probable heart failure was seen in a further 32 (0.8%) patients. In total, 124 (3.1%) of patients aged 45 years or older had definite or probable heart failure.

Richard Hobbs comments: "Prevalence rates indicate that heart failure is a major burden of disease in the United Kingdom. Accurate identification of all patients with heart failure is important since treatments are available that can alleviate symptoms, delay progression of the disorder, and improve prognosis."

In an accompanying Commentary (p 432), John McMurray and Mark Petrie from the University of Glasgow, UK, state that the study is a reminder that chronic heart failure remains a substantial global health problem. John McMurray comments: "Clearly a screening process is required to identify individuals with symptomless LVSD. The study in England confirms that most of these people have a recognised cardiovascular disorder (for example, past myocardial infarction, hypertension) and that almost all have an abnormal electrocardiogram. These and other demographic characteristics could allow targeted screening."
Contact: Professor F D Richard Hobbs, Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; T) 44-121-414-3760; F) 44-121-414-3050; E)f.d.r.hobbs@bham.ac.uk

Professor John J V McMurray, Department of Medicine and Therapeutics, Clinical Research Initiative in Heart Failure, Wolfson Building, University of Glasgow, GLASGOW G12 8QQ, UK; T/F) 44-141-330-6588; E) j.mcmurray@bio.gla.ac.uk


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