Age and Ageing Advance Access originally published online on July 22, 2004
Age and Ageing 2004 33(5):488-492; doi:10.1093/ageing/afh181
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Age and Aging Vol. 33 No. 5 © British Geriatrics Society 2004; all rights reserved
Research Paper |
Left ventricular systolic dysfunction and atrial fibrillation in older people in the community – a need for screening?
1 University Department of Geriatric Medicine, Llandough Hospital, Cardiff, UK
2 Welsh Cancer Intelligence and Surveillance Unit, Cardiff, UK
3 Department of Epidemiology, Statistics and Public Health Medicine, University of Wales College of Medicine, Cardiff, UK
4 University Hospital of Wales, Cardiff, UK
Address correspondence to: M. S. O'Mahony, University Department of Geriatric Medicine, 3rd Floor, Academic Centre, Llandough Hospital, Penlan Road, Penarth, Vale of Glamorgan CF64 2XX, UK. Fax: (+44) 29 207 11267. Email: omahonyms{at}cf.ac.uk
Abstract
Background: heart failure and stroke are major causes of morbidity and mortality in older people. Angiotensin converting enzyme inhibitors improve symptoms and survival in left ventricular systolic dysfunction. Anticoagulants are effective in stroke prevention in atrial fibrillation with aspirin being a less effective alternative.
Objectives: to determine the prevalence of left ventricular systolic dysfunction, health services utilisation and prescribing of diuretics and angiotensin converting enzyme inhibitors in left ventricular systolic dysfunction, and the prevalence of atrial fibrillation and anti-platelet/thrombotic therapy in atrial fibrillation in older people in the community.
Methods: 500 subjects were drawn by two-stage random sampling from 5,002 subjects aged 70 years and over living at home. Subjects were screened for atrial fibrillation and left ventricular systolic dysfunction using electrocardiography and echocardiography.
Results: the population prevalence amongst older people of left ventricular systolic dysfunction was 9.8% and of atrial fibrillation 7.8%. More than two-thirds of those with left ventricular systolic dysfunction were not on angiotensin converting enzyme inhibitors. Of those in atrial fibrillation, 35% were taking aspirin, 24% were taking warfarin and 41% were on neither aspirin nor warfarin. Nearly 90% of older people in the community have had contact with their general practitioner over the past year, and over half of those with left ventricular systolic dysfunction have had contact with hospital-based services over the past 2 years.
Conclusions: left ventricular systolic dysfunction is under-treated in older people in the community. Despite the high level of contact with hospital and community-based services, the majority of those with systolic left ventricular dysfunction are not on angiotensin converting enzyme inhibitors and a significant proportion of those in atrial fibrillation are not on any treatment for stroke prevention.
Keywords: left ventricular systolic dysfunction, atrial fibrillation, older people, anticoagulation, angiotensin converting enzyme inhibitors, screening, community, elderly
Received January 29, 2004; Revision received April 29, 2004. accepted in revised form April 29, 2004.
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