Understanding heart failure in the elderly with respect to diastolic dysfunction and role for natriuretic peptides

The current issue of the Journal of Geriatric Cardiology contains an interesting paper by Dr. Yixin Song and colleagues raising important issues in the diagnosis and management of heart failure in elderly patients. Readers of this journal are in all likelihood aware that the epidemic of heart failure is of great impact medically and economically worldwide. The primary risk factors for heart failure are age, coronary artery disease (CAD), and hypertension, with diabetes, valvular heart disease, and non-ischemic cardiomyopathies also contributing to heart failure rates.1 Recent estimates for the US put heart failure prevalence at 5.2 million cases with an annual incidence of 600,000 new cases per year.2 Extrapolations from limited data provide an estimate of 23 million cases of heart failure in China with an annual incidence of 2.6 million cases.2 Percentage of total deaths due to heart failure is likely higher in China than the US: heart failure mortality is estimated of 8. 5% of all deaths in Shanghai and 6% in Beijing versus only 2% in US, though the statistics from Hong Kong and Taiwan show a similar 2% as in the US.' Reasons for the higher rates of mortality from heart failure in Shanghai and Beijing compared to US despite much lower rates of CAD likely include higher rates of non-coronary heart disease and uncontrolled hypertension, along with delayed diagnosis and reduced access to medical treatment. Heart failure mortality rates have declined by 2/3 in Japan in the past 10 years, presumably in large part due to improved medical management, but have been unchanged in Shanghai.' This discrepancy suggests that China has the opportunity to dramatically reduce heart failure morbidity and mortality as it moves toward implementation of more aggressive efforts to diagnose and manage heart failure. The paper by Song and colleagues, while reporting on only a small number of patients from a solely diagnostic perspective, is an important marker of increased interest in heart failure evaluation and management in China.