Prevalence of preclinical and clinical heart failure in the elderly. A population-based study in Central Italy

We conducted a population-based cross-sectional study to assess the prevalence of both preclinical and clinical heart failure (HF) in the elderly. A sample of 2001 subjects, 65- to 84-year-old residents in the Lazio Region (Italy), underwent physical examination, biochemistry/N-terminal pro brain natriuretic peptide (NT-proBNP) assessment, electrocardiography, and echocardiography. Systolic left ventricular dysfunction (LVD) was defined as left ventricular ejection fraction (LVEF) 50. Diastolic LVD was defined by a Doppler-derived multiparametric algorithm. The overall prevalence of HF was 6.7 [95 confidence interval (CI) 5.67.9], mainly due to HF with preserved LVEF (HFpEF) (4.9; 95 CI 4.05.9), and did not differ by gender. A systolic asymptomatic LVD (ALVD) was detected more frequently in men (1.8; 95 CI 1.02.7) than in women (0.5; 95 CI 0.11.0; P 0.005), whereas the prevalence of diastolic ALVD was comparable between genders (men: 35.8; 95 CI 32.738.9; women: 35.0; 95 CI 31.938.2). The NT-proBNP levels and severity of LVD increased with age. Overall, 1623 subjects (81.1 of the entire studied population) had preclinical HF (Stage A: 22.2 and stage B: 59.1 respectively). A large number of subjects in stage B of HF showed risk factor levels not at target. In a population-based study, the prevalence of preclinical HF in the elderly is high. The prevalence of clinical HF is mainly due to HFpEF and is similar between genders.