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A screening echocardiogram to identify diastolic dysfunction leads to better outcomes
Author(s) -
Ghany Reyan,
Palacio Ana,
Chen Gordon,
Dawkins Elissa,
Ghany Alina,
Forbes Emancia,
Tajiri Thiago,
Tamariz Leonardo
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13615
Subject(s) - asymptomatic , medicine , heart failure , ejection fraction , cardiology , diastole , stage (stratigraphy) , diuretic , heart failure with preserved ejection fraction , loop diuretic , statin , blood pressure , paleontology , biology
Background Diastolic dysfunction (DD) can lead to heart failure and higher mortality. Echocardiograms can detect DD but are not indicated for screening in older adults. Our aim was to evaluate the prevalence of DD and the impact of identifying it in seniors. Methods We performed screening echocardiograms in 5227 consecutive patients between January 2014 and March 2015 in 36 senior‐focused value‐based clinics across six states. We determined the presence of the grade of DD and defined stage B grade II/III (asymptomatic) and of stage C grade II/III (symptomatic) DD by the presence or absence of typical HF symptoms. We obtained prescribed medications from the electronic health record to determine absolute changes in HF therapy before and after the echocardiogram. Results We included a group with no DD (n=649), a group with grade 1 DD (n=2875), and those with grades 2 and 3 (n=1357) who had normal ejection fraction. The prevalence of grade 2 or 3 DD with preserved ejection fraction was 25%; 95% CI: 24–26. The absolute change of ace‐inhibitor use before and after the echocardiogram increased by 14, 19, 23, 27 in patients without DD, those with grade 1, grade 2 or 3 asymptomatic and grade 2 or 3 symptomatic, respectively. The use of β‐blocker, statin, and diuretic had similar trends. Conclusions Seniors without previously known stage B or stage C heart failure have moderate‐to‐severe DD, 27% of whom were stage C. Identifying seniors with DD leads to improvement in care.