Detection of unrecognized clinical heart failure in elderly hypertensive women attended in primary care setting

Figures & data

Figure 1. Proportion of major and minor criteria of Framingham for the diagnosis of heart failure.

Table I. Clinical profile of the study population according to the presence of unrecognized heart failure or no heart failure.

Variable	Unrecognized HF (n=920)	No HF (n=2580)	p
Clinical characteristics
Age (years)	73.3±5.9	72.9±5.8	<0.0001
Body mass index (kg/m^2)	30.2±4.8	29.1±4.7	<0.0001
Waist circumference (cm)	98.6±14.3	95.0±13.4	<0.0001
Atrial fibrillation (%)	16.3	6.6	<0.0001
Time of evolution of hypertension >5 years (%)	73.3	65.9	<0.0001
Systolic blood pressure (mmHg)	147.6±15.8	142.0±15.2	<0.0001
Diastolic blood pressure (mmHg)	85.9±9.4	81.8±9.5	<0.0001
Heart rate (beats/min)	80.9±11.5	76.5±9.2	<0.0001
Cardiovascular risk factors
Sedentary lifestyle (%)	80.3	60.3	<0.0001
Dyslipidemia (%)	71.0	59.7	<0.0001
Diabetes (%)	46.2	33.4	<0.0001
History of premature CVD (%)	22.1	13.5	<0.0001
Smoking (current+ex-smokers) (%)	12.3	8.9	0.0083
C-reactive protein ≥1 mg/dl (%)	8.3	3.5	<0.0001
Target organ damage
Left ventricular hypertrophy (%)	54.1	15.5	<0.0001
Microalbuminuria (%)	23.2	9.8	<0.0001
Slight increase in plasma creatinine (1.2–1.4 mg/dl) (%)	22.3	9.5	<0.0001
Carotid wall thickening (IMT>0.9 mm) or plaque (%)	8.6	2.4	<0.0001
CVD
Coronary heart disease (%)	24.8	9.8	<0.0001
Peripheral artery disease (%)	22.5	8.3	<0.0001
Cerebrovascular disease (%)	18.3	8.9	<0.0001
Renal disease (creatinine >1.4 mg/dl) (%)	11.7	3.9	<0.0001
Advanced retinopathy (%)	5.9	2.2	<0.0001

HF, heart failure. CVD, cardiovascular disease; IMT, intima media thickening.

Table II. Predictive factors involved in unrecognized heart failure.

Variable	Odds ratio	95% CI	p
Left ventricular hypertrophy	4.843	(4.015–5.842)	<0.0001
CVD	2.259	(1.867–2.732)	<0.0001
Coronary heart disease	1.976	(1.557–2.507)	<0.0001
No systolic blood pressure control	1.972	(1.631–2.385)	<0.0001
Microalbuminuria	1.610	(1.259–2.060)	0.0002
Renal impairment	1.575	(1.259–1.971)	<0.0001
Smoking	1.487	(1.117–1.981)	0.0066
Obesity	1.312	(1.095–1.572)	0.0032

CVD, cardiovascular disease.

Figure 2. Blood pressure control rates. HF, heart failure.

Table III. Medication according to the presence of unrecognized heart failure or no heart failure.

	Unrecognized HF	No HF	p
Antihypertensive agents
1 (%)	22.9	43.5	<0.0001
2 (%)	53.4	41.6
>2 (%)	23.7	14.9
Diuretics (%)	72.3	52.8	<0.0001
ACEis (%)	41.8	33.6	<0.0001
ARB (%)	48.6	51.4	NS
CCBs (%)	19.0	17.4	NS
Beta-blockers (%)	14.7	11.2	<0.0001
Alpha-blockers (%)	3.4	2.9	NS
Aldosterone antagonists (%)	2.2	0.8	<0.0001
Antiplatelets (%)	47.4	30.0	<0.0001
Anticoagulants (%)	6.5	3.8	<0.0001
Nitrates (%)	8.0	2.7	<0.0001
Digoxine (%)	5.9	1.5	<0.0001
Antiarrhythmic agents (%)	4.7	2.2	<0.0001
Statins (%)	70.5	56.0	<0.0001
Oral antidiabetics (%)	44.1	32.3	0.001
Insulin (%)	11.6	7.1	<0.0001

HF, heart failure, ACEis, angiotensin-converting enzyme inhibitors; ARB, angiotensin II receptor blockers; CCBs, calcium-channel blockers.

Table IV. Diagnostic procedures performed according to the suspicion of heart failure.

Diagnostic tools	Suspected HF	No suspected HF	p
Electrocardiogram (%)	69.6	77.1	<0.0001
Chest X-ray (%)	65.8	45.5	<0.0001
Echocardiogram (%)	80.2	35.8	<0.0001
Blood sample analyses (%)	42.9	38.6	<0.0001
Brain natriuretic peptides (%)	6.8	1.3	<0.0001
Stress testing (%)	0.5	0.3	NS

HF: heart failure.