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Congestive Heart Failure Due to Diastolic or Systolic Dysfunction
Frequency and Patient Characteristics in an Ambulatory Setting
Philip M. Diller, MD, PhD;
Douglas R. Smucker, MD, MPH;
Brenda David, RN;
Robert J. Graham, PhD
Arch Fam Med. 1999;8:414-420.
Objective To determine the age- and> sex-specific frequencies and characteristics of patients with diastolic and systolic dysfunction heart failure.
Design Retrospective medical record survey encompassing 1 year.
Setting Community-based family practice office.
Patients One hundred thirty-six patients who met the modified Framingham criteria for the diagnosis of congestive heart failure (CHF) and had a known left ventricular ejection fraction. Diastolic dysfunction was defined as an ejection fraction of 45% or greater and systolic dysfunction heart failure as an ejection fraction of less than 45%.
Main Outcome Measures Age- and sex-specific frequency; patient comorbid conditions; medications taken; and number of emergency department visits, hospitalizations, and deaths.
Results The frequency of CHF increased with age for men and women (1.3% for patients 45-54 years old to 8.8% for patients >75 years old). The distribution according to left ventricular ejection fraction and age varied according to sex. Women had later onset of CHF that was predominantly diastolic dysfunction heart failure. Men had proportionately more systolic dysfunction heart failure at all ages. Forty percent of all patients with CHF had diastolic heart failure, and these patients had fewer functional limitations (76% with New York Heart Association classes I and II), fewer hospitalizations for CHF, and a trend toward fewer deaths during the study year compared with patients with systolic dysfunction.
Conclusions Congestive heart failure is a heterogeneous condition in this family practice setting, and diastolic dysfunction heart failure occurs frequently. Further study of the natural history and treatment of diastolic dysfunction heart failure should be performed in the primary care setting.
From the Department of Family Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
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