News

Undetected heart failure a big problem in care homes, says research

(24 April 2013)

One in five elderly people living in care homes may be living with undiagnosed heart failure, according to research.

The researchers, led by Durham University, diagnosed heart failure in almost a quarter of the residents within the study with the vast majority of these cases previously undiagnosed. The study also found that three quarters of previously recorded cases of heart failure were misdiagnosed.

The study suggests heart failure, and the accurate diagnosis of it, is a much bigger problem in care homes than previously believed with people’s quality of life severely affected. The scientists say early accurate diagnosis of different types of heart failure is key to effective management of the condition which may be failing in long-term care facilities.

The study is published in the European Journal of Heart Failure and was conducted by Durham University, Darlington Memorial Hospital and The James Cook University Hospital. The Heart Failure in Care Homes (HFinCH) study was funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme.

The scientists medically examined 399 residents aged 65-100 years in 33 UK care facilities. The presence of heart failure was determined by an evaluation of symptoms and signs, functional capacity, quality of life, portable on-site echocardiography* and review of the medical record. 

Heart failure is a condition in which the heart does not pump blood around the body effectively. Symptoms often include breathlessness, tiredness and swelling of the legs and ankles.

The findings of the study challenge the current focus on diagnosis and treatment of undifferentiated heart failure amongst elderly people in care homes.

Clearly defined sub-types of heart failure, heart failure with diastolic dysfunction and heart failure with systolic dysfunction, were diagnosed within the residents of the care homes with high rates of heart failure with diastolic dysfunction.

Lead author, Dr Helen Hancock from the School of Medicine, Pharmacy and Health, said: “The lack of an accurate diagnosis of heart failure means people do not receive the appropriate care and will continue to suffer often debilitating symptoms such as breathlessness and swelling of the legs and ankles. In elderly people living in care homes, these symptoms are often on top of other health problems.

“As most people within care homes have multiple health problems, symptoms and signs of heart failure can sometimes be attributed to other conditions. For example, symptoms such as fluid retention (oedema) and breathlessness (dyspnoea) are just as common in older people in care homes without heart failure as in those with heart failure making it more difficult to use these symptoms as indicators of the condition.

“Routine use of portable echocardiography in care facilities might be essential to ensure people get an accurate diagnosis and specific appropriate treatment.”

Co-author Dr Jerry Murphy, a cardiologist at Darlington Memorial Hospital, said: “Heart failure is a chronic and debilitating condition, but there are effective treatments which improve symptoms and quality of life.

“By using simple investigations, including blood tests and echocardiogram, this study has shown that heart failure can be correctly diagnosed and the right medication started.”

June Davison, Senior Cardiac Nurse at the British Heart Foundation (BHF), said: “Official figures show that around 750,000 people in the UK are living with heart failure, but there may be many more who are undiagnosed.

“It’s essential heart failure is spotted as early as possible, because getting the right treatment can greatly improve people’s quality of life.”

* An echocardiogram (also known as an echo) uses sound waves that echo against structures in the heart to build up a detailed picture of the heart. The test looks at the structure of the heart and how well the heart functions. It is a similar sort of scan to the ultrasound used in pregnancy.