Heart failure (HF) is a highly prevalent chronic disease in older persons. Its prevalence increases with age reaching 15–20% in those aged over 80
]. According to current guidelines [2
], HF is stated as a clinical syndrome characterized by the presence of symptoms and typical signs of HF and objective evidence of a structural and/or functional abnormality of the heart, usually illustrated by echocardiography [2
]. Accurate diagnosis of the presence and aetiology of HF is important given its crucial influence on therapy. However, signs and symptoms of HF in older persons are often obscured, due to physical limitations or the unreliability of clinical history due to dementia [3
]. In addition, signs of HF, such as fatigue or dyspnoea, are often attributed to the normal ageing process. Besides, symptoms are often non-specific and can be attributed to other common diseases in older persons such as venous insufficiency or obesity [4
]. The diagnosis of HF is especially challenging if co-morbidities are present that share common symptoms of HF are present such as COPD and venous insufficiency [5
This implicates that the diagnosis of HF is particularly difficult in older persons and nursing home residents. The latter represent a specific group, involving very frail and disabled elderly persons with chronic somatic diseases or progressive dementia, both often being complicated by co-morbidities [6
]. The prevalence of HF in nursing home residents is estimated to be 20–25% [3
]. Furthermore, HF in this specific group is likely to be underdiagnosed, due to the lack of knowledge regarding adequate diagnosis and treatment of HF in this population. This counts the more because nursing home residents are often excluded from clinical and epidemiological studies.
It is well known that HF is accompanied by a high patient and economic burden [8
]. HF patients are often re-admitted to hospital, mainly due to periodic episodes of clinical deterioration [9
]. In the Netherlands, as well as other Western countries cardiovascular diseases (including HF) account for the highest hospitalisation rate, resulting in high financial costs [10
Notwithstanding the fact that survival of HF has improved in recent decades, once hospitalised for heart failure, 33% of elderly patients die within the following year [12
]. Women and older persons experience less improvement in survival, partly because they often suffer from HF with a preserved ejection fraction, but also because they are less likely to receive treatment with B-blockers and ACE-inhibitors [12
HF also leads to an impaired quality of life [14
]. The symptoms of HF such as fatigue and dyspnoea result in increased care dependency which is accompanied by a decline in health status and quality of life [16
]. Therefore, early diagnosis and treatment of HF may prevent the progression of heart failure and lead to improvement in symptoms and quality of life [17
]. Furthermore, it is known that older persons are less likely to receive evidence-based treatments for HF [18
]. Although ACE- inhibitors have been demonstrated to benefit HF patients, they remain underused for HF treatment in nursing home settings [19
The aim of this study is to gain an insight into the prevalence and management of HF in nursing home residents and to explore the association between HF, care dependency and quality of life.
The following research questions will be addressed:
1.What is the prevalence of HF in Dutch nursing home residents?
2. How is HF currently treated in nursing home residents both pharmacologically and non-pharmacologically?
3. What is the association between HF and the care dependency and quality of life of nursing home residents?
This article describes the study protocol.