scholarly journals Comorbidity and polypharmacy in chronic heart failure: a large cross-sectional study in primary care

2017 ◽  
Vol 67 (658) ◽  
pp. e314-e320 ◽  
Author(s):  
Bosco Baron-Franco ◽  
Gary McLean ◽  
Frances S Mair ◽  
Veronique L Roger ◽  
Bruce Guthrie ◽  
...  
Keyword(s):  
Mental Health ◽  
Heart Failure ◽  
Primary Care ◽  
Chronic Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Sectional Study ◽  
Cross Sectional

BackgroundComorbidity is common in heart failure, but previous prevalence estimates have been based on a limited number of conditions using mainly non-primary care data sources.AimTo compare prevalence rates of comorbidity and polypharmacy in those with and without chronic heart failure due to left ventricular systolic dysfunction (LVSD).Design and settingA cross-sectional study of 1.4 million patients in primary care in Scotland.MethodData on the presence of LVSD, 31 other physical, and seven mental health comorbidities, and prescriptions were extracted from a database of 1 424 378 adults. Comorbidity prevalence was compared in patients with and without LVSD, standardised by age, sex, and deprivation. Pharmacology data were also compared between the two groups.ResultsThere were 17 285 patients (1.2%) who had a diagnosis of LVSD. Compared with standardised controls, the LVSD group had greater comorbidity, with the biggest difference found for seven or more conditions (odds ratio [OR] 4.10; 95% confidence interval (CI] = 3.90 to 4.32). Twenty-five physical conditions and six mental health conditions were significantly more prevalent in those with LVSD relative to standardised controls. Polypharmacy was higher in the LVSD group compared with controls, with the biggest difference found for ≥11 repeat prescriptions (OR 4.81; 95% CI = 4.60 to 5.04). However, these differences in polypharmacy were attenuated after controlling for the number of morbidities, indicating that much of the additional prescribing was accounted for by multimorbidity rather than LVSD per se.ConclusionExtreme comorbidity and polypharmacy is significantly more common in patients with chronic heart failure due to LVSD. The efficient management of such complexity requires the integration of general and specialist expertise.

scholarly journals Cross sectional study estimating prevalence of heart failure and left ventricular systolic dysfunction in community patients at risk

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 172-178 ◽  
Author(s):  
O W Nielsen ◽  
J Hilden ◽  
C T Larsen ◽  
J F Hansen
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Heart Disease ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Cross Sectional ◽  
General Practices

OBJECTIVETo examine a general practice population to measure the prevalence of signs and symptoms of heart failure (SSHF) and left ventricular systolic dysfunction (LVSD).DESIGNCross sectional screening study in three general practices followed by echocardiography.SETTING AND PATIENTSAll patients ⩾ 50 years in two general practices and ⩾ 40 years in one general practice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjects were sought who had SSHF (n = 115). Of 357 subjects with evidence of heart disease, 252 were eligible for examination, and 126 underwent further cardiological assessment, including 43 with SSHF.MAIN OUTCOME MEASURESPrevalence of SSHF as defined by a modified Boston index, LVSD defined as an indirectly measured left ventricular ejection fraction ⩽ 0.45, and numbers of subjects needing an echocardiogram to detect one case with LVSD.RESULTSSSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogenarians. Two thirds were handled in primary care only. At ⩾ 50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confidence interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 patients with SSHF had to be examined.CONCLUSIONSSHF is extremely prevalent in the community, especially in primary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect one case of LVSD is 14.

Heart Failure and Asymptomatic Left Ventricular Systolic Dysfunction in Lymphoma Survivors Treated With Autologous Stem-Cell Transplantation: A National Cross-Sectional Study

2015 ◽  
Vol 33 (24) ◽  
pp. 2683-2691 ◽  
Author(s):  
Klaus Murbraech ◽  
Knut B. Smeland ◽  
Harald Holte ◽  
Jon Håvard Loge ◽  
May Brit Lund ◽  
...  
Keyword(s):  
Risk Factors ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Sectional Study ◽  
Ventricular Systolic Dysfunction ◽  
Cross Sectional ◽  
The Mean ◽  
Lymphoma Survivors

Purpose We aimed to determine the prevalence of left ventricular systolic dysfunction (LVSD), including symptomatic (ie, heart failure [HF]) and asymptomatic LVSD in adult lymphoma survivors (LSs) after autologous hematopoietic stem-cell transplantation (auto-HCT) and to identify risk factors for LVSD in this population. Patients and Methods All LSs treated with auto-HCT as adults in Norway from 1987 to 2008 were eligible for this national cross-sectional study. Asymptomatic LVSD was defined as left ventricular ejection fraction less than 50% by echocardiography, and HF was defined according to current recommendations. The results in LSs were compared with those found in an age- and sex-matched (1:1) control group. Results We examined 274 LSs (69% of all eligible survivors); 62% were men, the mean (± standard deviation) age was 56 ± 12 years, and mean follow-up time from lymphoma diagnosis was 13 ± 6 years. The mean cumulative doxorubicin dose was 316 ± 111 mg/m2, and 35% of LSs had received additional radiation therapy involving the heart. We found LVSD in 15.7% of the LSs, of whom 5.1% were asymptomatic. HF patients were symptomatically mildly affected, with 8.8% of all LSs classified as New York Heart Association class II, whereas more severe HF was rare (1.8%). Compared with controls, LSs had a substantially increased LVSD risk (odds ratio, 6.6; 95% CI, 2.5 to 17.6; P < .001). A doxorubicin dose ≥ 300 mg/m2 and cardiac radiation therapy dose greater than 30 Gy were independent risk factors for LVSD. Conclusion LVSD was frequent and HF more prevalent than previously reported in LSs after auto-HCT. Our results may help to identify LSs at increased LVSD risk and can serve as a basis for targeted surveillance strategies.

scholarly journals Left Atrial Enlargement an Early Predictor for Development of Systolic Dysfunction – Results of a Cross-Sectional Study Conducted in Georgia

2017 ◽  
Vol 13 (33) ◽  
pp. 1
Author(s):  
Eka Rukhadze ◽  
Nino Tabagari-Bregvadze ◽  
Levan Tvildiani
Keyword(s):  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Sectional Study ◽  
Cross Sectional ◽  
Ventricular Ejection Fraction ◽  
Early Predictor

Background and Aims: Left ventricular systolic dysfunction, even asymptomatic, is associated with the development of heart failure (HF) and all-cause mortality. Left ventricular ejection fraction (LVEF) is the most commonly used marker of left ventricular systolic function. It is well established that early detection and treatment of reduced LVEF, as well as the aggressive management of predisposing conditions, delays the manifestation of HF. Our study aimed to measure the association between LVEF and other echocardiographic variables in a population with LVEF within the normal range and without symptoms of HF. Methods: We conducted a cross-sectional study in 2008-2009. Results: We analyzed echocardiographic and clinical data of 146 patients: 66.4% were women; mean age was 55 (40 –69 years). LVEF significantly correlated only with left atrium (LA) size (Beta -0.266, p < 0.05). The correlation was inverse and remained significant after adjusting for age, gender, obesity, diabetes, arterial hypertension, left ventricular hypertrophy, pulmonary systolic pressure, mitral regurgitation, and diastolic dysfunction. Conclusions: We found that the earliest structural change associated with LVEF tendency to decrease was LA size. Further research is needed to assess the LA enlargement as an early predictor of systolic dysfunction development.

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