We developed a multivariate model using forward selection with an entry criterion of P?0.05 using a likelihood ratio test (see table ?table4).4). having mild, moderate, or severe dysfunction, the mean ejection fraction was 48% (SD 12.0), 38% (8.1), and 26% (7.9) respectively. At all ages the prevalence was much higher in men than in women (odds ratio 5.1, 95% confidence interval 2.6 to 10.1). No clinical symptom or sign was both sensitive and specific. In around half the patients with ventricular dysfunction (52%, 32/61) heart failure had not been previously diagnosed. Conclusions Unrecognised left ventricular dysfunction is a common problem in elderly patients in the general practice setting. Appropriate treatment with angiotensin converting enzyme inhibitors has the potential to reduce hospitalisation and mortality in these patients, but diagnosis should not be based on clinical history and examination alone. Screening is feasible in general practice, but it should not be implemented until the optimum method of identifying left ventricular dysfunction is clarified, and the cost effectiveness of screening has been shown. Key messages Left ventricular dysfunction detected by echocardiography is common in elderly people Men are much more likely to be affected than women The accuracy of clinical diagnosis is very limited in this age group Many patients who would benefit from treatment remain undetected Introduction Heart failure is a common cause of hospitalisation and death across the industrialised world. In contrast to coronary artery disease and stroke, the number of hospital admissions and deaths attributed to heart failure is increasing, and this rise is predicted to continue.1C4 Improving the diagnosis and care of patients with heart failure is therefore likely to have a major impact on morbidity, mortality, and healthcare costs, which in the United Kingdom are estimated to be 360 million a year.5 Systolic left ventricular dysfunction, which can be observed by echocardiography, is the commonest cause of the clinical syndrome of heart failure. Clinical trials have shown that treatment, particularly with angiotensin converting enzyme inhibitors, can increase survival and improve quality of life for patients with severe, moderate, and mild systolic left ventricular dysfunction.6C9 The substantial protective effect of treatment on mortality and hospitalisation has been shown in a meta analysis (odds ratio 0.65, 95% confidence interval 0.57 to 0.74).10 Progression to overt clinical heart failure can also be delayed by treatment of asymptomatic left ventricular dysfunction.11 The ability to develop a coherent strategy to apply the evidence in a community setting is limited by a lack of knowledge about the extent, severity, and age distribution of left ventricular systolic dysfunction in the general population.12 The prevalence of clinical heart failure has been reported from Framingham13 and elsewhere,14 but knowledge of the prevalence of left ventricular systolic dysfunction, as determined by echocardiography, in the United Kingdom is limited to one cross sectional survey in Glasgow of patients aged 25-74 years.15 This survey was restricted to responders to the 1992 monitoring trends and determinants in cardiovascular disease risk factor survey and included few patients from elderly age groups, who contribute most to the overall burden of heart failure. Our study aimed to determine the prevalence of left ventricular systolic dysfunction, as detected by echocardiography, in patients from an unselected general 3,4-Dihydroxymandelic acid practice population aged over 70 years. Subjects and methods Sample We selected a random sample of 1200 individuals aged 70-84 years from the age-sex register of a large four centre group general practice in Poole, Dorset. Of these patients, we excluded 144 (12.0%) as they had died or were no longer registered with the practice. The remaining 1056 patients were invited to attend for clinical and echocardiographic examination. Housebound patients were offered a home assessment. In total, 817 (77.4%) individuals received an echocardiographic assessment. The mean age of those assessed was 76.1 years (SD 3.9 years), and 442 (54.1%) of them were women. Individuals who declined assessment were slightly older (mean 77.0 years, SD 4.2, P=0.004) and more likely to be ladies (62.0%, P=0.03). The study was authorized by the local study ethics committee. Clinical assessment We collected data on 12 medical symptoms and indications that are commonly regarded as by clinicians in main care in the analysis of heart failure. The symptoms were breathlessness at rest, when walking, when IL12RB2 seeking to sleep, and at any time in the previous two. The blood pressure recorded was the mean of two readings taken with the patient rested and sitting, using an automatic sphygmomanometer (UA-751, A and D Medical, Tokyo). Echocardiography A detailed echocardiographic exam was performed by an experienced senior cardiac technician without reference to the clinical findings of the doctor, using a Sonos 100 CF (Hewlett Packard, MS, USA) cardiovascular imaging system providing two dimensional echocardiography, spectral Doppler and colour Doppler circulation mapping info using a 2.5 or 3.5?MHz duplex transducer and a 1.9?MHz sound only continuous wave Doppler transducer. was 48% (SD 12.0), 38% (8.1), and 26% (7.9) respectively. Whatsoever age groups the prevalence was much higher in males than in ladies (odds percentage 5.1, 95% confidence interval 2.6 to 10.1). No medical symptom or sign was both sensitive and specific. In around half the individuals with ventricular dysfunction (52%, 32/61) heart failure had not been previously diagnosed. Conclusions Unrecognised remaining ventricular dysfunction is definitely a common problem in 3,4-Dihydroxymandelic acid seniors patients in the general practice establishing. Appropriate treatment with angiotensin transforming enzyme inhibitors has the potential to reduce hospitalisation and mortality in these individuals, but diagnosis should not be based on medical history and exam alone. Screening is definitely feasible in general practice, but it should not be implemented until the optimum method of identifying remaining ventricular dysfunction is definitely clarified, and the cost effectiveness of 3,4-Dihydroxymandelic acid testing has been shown. Key messages Remaining ventricular dysfunction recognized by echocardiography is definitely common in elderly people Men are much more likely to be affected than ladies The accuracy of medical diagnosis is very limited with this age group Many patients who would benefit from treatment remain undetected Intro Heart failure is definitely a common cause of hospitalisation and death across the industrialised world. In contrast to coronary artery disease and stroke, the number of hospital admissions and deaths attributed to heart failure is increasing, and this rise is expected to continue.1C4 Improving the analysis and care of individuals with heart failure is therefore likely to have a major impact on morbidity, mortality, and healthcare costs, which in the United Kingdom are estimated to be 360 million a yr.5 Systolic remaining ventricular dysfunction, which can be observed by echocardiography, is the commonest cause of the clinical syndrome of heart failure. Medical trials have shown that treatment, particularly with angiotensin transforming 3,4-Dihydroxymandelic acid enzyme inhibitors, can increase survival and improve quality of life for individuals with severe, moderate, and slight systolic remaining ventricular dysfunction.6C9 The substantial protective effect of treatment on mortality and hospitalisation has been shown inside a meta analysis (odds ratio 0.65, 95% confidence interval 0.57 to 0.74).10 Progression to overt clinical heart failure can also be delayed by treatment of asymptomatic remaining ventricular dysfunction.11 The ability to develop a coherent strategy to apply the evidence inside a community setting is limited by a lack of knowledge about the extent, severity, and age distribution of remaining ventricular systolic dysfunction in the general population.12 The prevalence of clinical heart failure has been reported from 3,4-Dihydroxymandelic acid Framingham13 and elsewhere,14 but knowledge of the prevalence of remaining ventricular systolic dysfunction, as determined by echocardiography, in the United Kingdom is limited to one cross sectional survey in Glasgow of individuals aged 25-74 years.15 This survey was restricted to responders to the 1992 monitoring trends and determinants in cardiovascular disease risk issue survey and included few patients from elderly age groups, who contribute most to the overall burden of heart failure. Our study aimed to determine the prevalence of remaining ventricular systolic dysfunction, as recognized by echocardiography, in individuals from an unselected general practice human population aged over 70 years. Subjects and methods Sample We selected a random sample of 1200 individuals aged 70-84 years from your age-sex register of a large four centre group general practice in Poole, Dorset. Of these individuals, we excluded 144 (12.0%) as they had died or were no longer registered with the practice. The remaining 1056 patients were invited to attend for medical and echocardiographic exam. Housebound patients were offered a home assessment. In total, 817 (77.4%) individuals received an echocardiographic assessment. The mean age of those assessed was 76.1 years (SD 3.9 years), and 442 (54.1%) of them were women. Individuals who declined assessment were slightly older (mean 77.0 years, SD 4.2, P=0.004) and more likely to be ladies (62.0%, P=0.03). The study was authorized by the local study ethics committee. Clinical assessment We collected data on 12 medical symptoms and indications that are commonly regarded as by clinicians in main care in the analysis of heart failure. The symptoms were breathlessness at rest, when walking, when seeking to sleep, and at any time in the previous two weeks. The signs were tachycardia ( 90 beats/min),.