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Association of Undifferentiated Dyspnea in Late Life With Cardiovascular and Noncardiovascular Dysfunction: A Cross-sectional Analysis From the ARIC Study.

TitleAssociation of Undifferentiated Dyspnea in Late Life With Cardiovascular and Noncardiovascular Dysfunction: A Cross-sectional Analysis From the ARIC Study.
Publication TypeJournal Article
Year of Publication2019
AuthorsRamalho SHR, Santos M, Claggett B, Matsushita K, Kitzman DW, Loehr LR, Solomon SD, Skali H
Secondary AuthorsShah AM
JournalJAMA Netw Open
Volume2
Issue6
Paginatione195321
Date Published2019 06 05
ISSN2574-3805
KeywordsAged, Aged, 80 and over, Body Mass Index, Comorbidity, Cross-Sectional Studies, Dyspnea, Female, Geriatric Assessment, Heart Failure, Humans, Male, Obesity, Odds Ratio, Risk Factors, Severity of Illness Index, United States, Ventricular Dysfunction, Left
Abstract

Importance: Undifferentiated dyspnea is common in late life, but the relative contribution of subclinical cardiac dysfunction is unknown. Impairments in cardiac structure and function may be characteristics of undifferentiated dyspnea in elderly people, providing potential insights into occult heart failure (HF).

Objective: To quantify the association of undifferentiated dyspnea with cardiac dysfunction after accounting for other potential contributors.

Design, Setting, and Participants: This cross-sectional study used data from Atherosclerosis Risk in Communities study participants 65 years and older who attended the fifth study visit (from 2011 to 2013) and had not been diagnosed with HF, chronic obstructive pulmonary disease, morbid obesity, or severe kidney disease. Analyses were conducted from October 2017 to June 2018.

Exposures: Dyspnea measured using the modified Medical Research Council scale, with a score less than 2 classified as none to mild and a score of 2 or more classified as moderate to severe.

Main Outcomes and Measures: Using multivariable logistic regression, the association of undifferentiated dyspnea was defined using cardiac structure, systolic and diastolic function, pulmonary pressure (echocardiography), pulmonary function (spirometry), glomerular filtration rate, hemoglobin, body mass index, depression, and physical performance. The population-attributable risk was calculated for each dysfunction metric.

Results: Among 4342 participants (mean [SD] age, 75.9 [5.0] years; 2533 [58.3%] women), 1173 (27.0%) had undifferentiated dyspnea. Moderate to severe dyspnea was present in 574 participants (13.2%) and was associated with left ventricular (LV) hypertrophy (odds ratio [OR], 1.53; 95% CI, 1.25-1.87; P 

Conclusions and Relevance: Undifferentiated dyspnea is multifactorial in older adults, and this study showed an association with obesity. When accounting for other relevant organ systems, cardiovascular function poorly discriminated those with vs those without dyspnea. Therefore, dyspnea should not be assumed to represent occult HF in this population.

DOI10.1001/jamanetworkopen.2019.5321
Alternate JournalJAMA Netw Open
PubMed ID31199443
PubMed Central IDPMC6575149
Grant ListHHSN268201700001I / HL / NHLBI NIH HHS / United States
R01 HL135008 / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
K08 HL116792 / HL / NHLBI NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States
R01 HL143224 / HL / NHLBI NIH HHS / United States