© 2007 European Society of Cardiology
Clinical syndrome suggestive of heart failure is frequently attributable to non-cardiac disorders — population-based study
a Department of Hygiene and Epidemiology, University of Porto Medical School Porto, Portugal
b Heart Failure Clinic, Department of Internal Medicine, Hospital S. João Porto, Portugal
c Department of Cardiology, Hospital S. João and University of Porto Medical School Porto, Portugal
d Institute of Epidemiology and Social Medicine, University of Muenster Muenster, Germany
* Corresponding author. Department of Hygiene and Epidemiology, University of Porto Medical School, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal. Tel.: +351 22 551 36 52; fax: +351 22 551 36 53. E-mail address: anazev{at}med.up.pt
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Abstract |
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Aim: To assess how often the clinical syndrome (CS) of heart failure is attributable to alternative, including non-cardiac, explanations.
Methods and results: Cross-sectional evaluation of 739 community participants aged 
45 years. Subjects with 2 symptoms or signs (dyspnoea or fatigue, orthopnoea, nocturnal paroxysmal dyspnoea, third heart sound, jugular venous distension, rales and lower limb oedema) or who were receiving loop diuretics were considered to have the clinical syndrome of heart failure. Attributable fractions were derived based on adjusted odds ratios and the prevalence of underlying disorders among cases. CS was present in 28.0% of women and in 15.2% of men, p<0.001. The multivariate-adjusted fraction of CS attributable to female gender was 40.6%, to age65 years 28.5%, left ventricular systolic dysfunction, left ventricular dilatation or moderate–severe valvular disease 4.9%, diastolic dysfunction or atrial fibrillation 13.0%, obesity 22.6%, coronary heart disease 7.2% and chronic lung disease 6.9%. When additionally adjusting for depressive symptoms, the association with gender and age became much weaker, and 32% of cases were attributable to depressive symptoms. Forty-two percent of subjects with CS had cardiac abnormalities.
Conclusion: In less than half of subjects with CS was systolic or diastolic heart failure confirmed. Female gender, older age, obesity and depressive symptoms accounted for the largest fraction of CS.
Key Words: Heart failure • Diagnosis • Preserved systolic function • Diastolic heart failure • Population-based study • Symptoms
Received April 12, 2006; Revised August 30, 2006; Accepted October 19, 2006
Department where the work was performed: Department of Hygiene and Epidemiology, University of Porto Medical School.
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