Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study

Background Accurate data for prevalence rates for heart failure due to various causes, and for left-ventricular systolic dysfunction in all adults are unavailable. Our aim was to assess prevalence of left-ventricular systolic dysfunction and heart failure in a large representative adult population in England. Methods Of 6286 randomly selected patients aged 45 years and older, 3960 (63%) participated in the study. They came from 16 randomly selected general practices. We assessed patients by history and examination, electrocardiography, and echocardiography. Prevalence of left-ventricular systolic dysfunction (defined as ejection fraction <40%) and heart failure was calculated for the overall population on the basis of strict criteria and, when necessary, adjudication by a panel. Findings Left-ventricular systolic dysfunction was diagnosed in 72 (1·8% [95% CI 1·4–2·3]) participants, half of whom had no symptoms. Borderline left-ventricular function (ejection fraction 40–50%) was seen in 139 patients (3·5% [3·0–4·1]). Definite heart failure was seen in 92 (2·3%, [1·9–2·8]) and was associated with an ejection fraction of less than 40% in 38 (41%) patients, atrial fibrillation in 30 (33%), and valve disease in 24 (26%). Probable heart failure was seen in a further 32 (0·8% [0·6–1·1]) patients. In total, 124 (3·1% [2·6–3·7]) patients aged 45 years or older had definite or probable heart failure. Interpretation Heart failure is often misdiagnosed or underdiagnosed in primary care. Our results suggest that assessment of left-ventricular function in patients with suspected heart failure could lead to more effective diagnosis and treatment of this disorder.