Heart Weakness Common but Undiagnosed in Some Older Patients

July 25, 2012— -- Older people living with heart abnormalities that could lead to heart failure may have never had those abnormalities diagnosed, meaning they miss out on treatments that could help, according to a new study. But deciding whether someone would benefit from taking these drugs in the last stages of life is important too, doctors say.

The heart naturally gets weaker as people age, but Bernard Keavney, a professor of cardiology at Newcastle University in Tyne, England, and the study's lead author, said scientists don't often study heart failure or the best way to treat it in the very old.

"We can only treat heart failure if we know it's there," Keavney said.

Keavney and his team went to the homes of about 375 people ages 87 to 89 living in northeast England, armed with equipment to test their heart function. They found that about one-third of them had a heart with a reduced ability to pump blood, called a left ventricular systolic dysfunction. Another 20 percent had a diastolic dysfunction -- heart muscles that could not relax enough to allow the heart's chambers to fill with blood, keeping the heart from pumping enough blood to the rest of the body.

People aren't born with these abnormalities, but they increase as people age and develop cardiovascular diseases, such as high blood pressure and coronary artery disease. They can also lead to heart failure, a condition in which the heart can't pump blood effectively to the rest of the body.

For 26 percent of the people in the study, the problems had never been diagnosed by a physician.

The findings were published Tuesday in the journal Heart.

It's not clear why these people had never gotten a diagnosis. Doctors say it could be that they simply didn't realize there was a problem and may have thought their symptoms, such as shortness of breath and fatigue, were simply part of old age.

"Likely because the level of activity in these patients in these kinds of home care settings is low, they don't stress their heart enough to know that there is a problem," said Dr. Robert Myerburg, a professor of medicine and physiology at the University of Miami Miller School of Medicine.

About 5.8 million Americans have heart failure, according the National Heart Lung and Blood Institute, and as greater numbers of people reach old age in many Western countries, it's possible that that number will grow.

Keavney said because greater numbers of people survive heart attacks, these kinds of heart abnormalities may increase.

"There would have been people in previous years would have come into the hospital after a heart attack and died from it. Now more may survive, but they're going home with a weakened heart," he said.

Doctors say although the symptoms of these heart abnormalities seem pretty common for older people, it's important that they not be dismissed as simply signs of "old age."

"There is no clinical diagnosis of 'old age,'" said Dr. Clyde Yancy, chief of cardiology at Northwestern Memorial Hospital and a past president of the American Heart Association. "We should keep our antenna up at all times for treatable diseases that may reduce symptoms and improve the quality of life."

For patients whose hearts don't relax enough to fill with blood, the treatment options are scarce. But patients whose hearts don't pump hard enough can take classes of drugs called beta blockers and ACE inhibitors, both of which increase the heart's ability to pump blood effectively.

Those drugs come with side effects, however, such as weakness, drowsiness or dizziness, that may make it not feasible or desirable to give them to an older person.

Myerburg said deciding which patients will benefit from taking drugs is important.

"If you've got an elderly person sitting around all day and not able to do very much who's not suffering from their symptoms, there's not a lot of benefit to gain from these drugs," he said. "If you've got a very spry and active individual who is limited by the symptoms, then the benefit becomes relatively more substantial."