Left ventricular systolic dysfunction prevalent in at-risk inpatients

Asymptomatic left ventricular systolic dysfunction (LVSD) is present in about 5% of general medical inpatients who have at least one risk factor for heart failure, research shows.

"Due in part to its poor prognosis and the likelihood that treatment will improve outcomes, identifying asymptomatic left ventricular systolic dysfunction may have a potentially

important impact on public health," write Glenn Hirsch (The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA) and colleagues in TheAmerican Journal of Medicine.

Of the 217 patients who consented to participate in the study, there were interpretable echocardiograph images available for 207. Patients were aged at least 45 years old and had one or more heart failure risk factors. Echocardiograms, conducted at bedside with a hand-carried device, revealed asymptomatic LVSD in 11 (5.3%) patients.

The 11 patients with LVSD had more risk factors than those who did not (3.1 vs 2.5), and none had fewer than two risk factors, "suggesting that selectively screening patients with two or more risk factors could be considered if further studies confirm this finding." The most significant risk factors associated with increased odds for having LVSD were male gender and coronary artery disease.

The presence of asymptomatic LVSD is known to be linked to greater rates of congestive heart failure and death. Treating asymptomatic LVSD with angiotensin-converting enzyme (ACE) inhibitors can help reduce morbidity and mortality. However, in this study, only five of the 11 patients with LVSD were taking ACE inhibitors at hospital admission.

Hirsch and colleagues acknowledge that screening for asymptomatic disease helps to prevent morbidity and mortality, and note that "the hospital setting may be ideal for left ventricular systolic dysfunction screening, given the availability of patients, trained personnel, and equipment."

"Reducing the frequency of incident heart failure requires better identification and management of clinical and echocardiographic risk factors, including asymptomatic left ventricular systolic dysfunction," the investigators add.

They conclude: "Optimally, bedside ultrasound screening by hospitalist providers could be performed as part of the routine admission evaluation in patients with heart failure risk factors. Further investigation into training nonspecialists to accurately perform limited hand-carried ultrasound and the cost-effectiveness and clinical outcomes of widespread screening of at-risk populations is warranted."

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