Article

Niet-herkend hartfalen bij oudere patiënten met chronisch obstructieve longziekte

Huisarts en wetenschap 12/2005; 48(12):122-128. DOI: 10.1007/BF03084158

ABSTRACT Rutten FH, Cramer M-J, Grobbee DE, Sachs APE, Kirkels JH, Lammers J-W, Hoes AW. Niet-herkend hartfalen bij oudere patiënten
met chronisch obstructieve longziekte. Huisarts Wet 2005;48(12):602-8.

Doel Vaststellen van de prevalentie van nog onbekend hartfalen bij oudere patiënten met chronisch obstructieve longziekte (COPD)
in een stabiele fase van hun ziekte.

Methode Wij deden een cross-sectioneel onderzoek waarbij wij patiënten van 65 jaar en ouder uitnodigden op onze polikliniek die van
hun huisarts de ICPC-code chronische bronchitis of COPD hadden gekregen. Patiënten die al een (door een cardioloog) echocardiografisch
vastgestelde diagnose hartfalen hadden, kregen geen uitnodiging. Alle deelnemers (n=405) werden uitgebreid onderzocht door
middel van anamnese (met voorgeschiedenis), lichamelijk onderzoek, longfoto, elektrocardiografie, bloedonderzoek, echocardiografie
en longfunctieonderzoek. Als gouden standaard voor de diagnose hartfalen en/of COPD gebruikten we de mening van een panel
dat bestond uit twee cardiologen, een huisarts en een longarts. Dit panel baseerde de diagnose hartfalen op alle beschikbare
resultaten van de diagnostische onderzoeken. Conform de diagnostische criteria van de Europese Sociëteit voor Cardiologie
(ESC) was er sprake van hartfalen indien er klachten waren die pasten bij hartfalen in combinatie met echocardiografisch vastgestelde
(systolische en/of diastolische) ventrikeldisfunctie.

Voor de diagnose COPD golden de diagnostische criteria van de Global Initiative for COPD (GOLD).

Resultaten Van de 405 deelnemers hadden er 83 (20,5%, 95%-BI 16,7-24,8) hartfalen bij wie dat niet eerder onderkend was. Bij 42 patiënten
betrof het systolisch, bij 41 geïsoleerd diastolisch en bij niemand geïsoleerd rechtszijdig hartfalen. In totaal hadden 244
(60,2%) patiënten COPD volgens de GOLD-criteria, van wie 50 (20,5%, 95%-BI 15,6-26,1) in combinatie met hartfalen.

Conclusie Bij oudere patiënten met een huisartsdiagnose COPD of chronische bronchitis wordt hartfalen vaak niet herkend. Om de diagnostiek
en behandeling van hartfalen bij deze grote groep patiënten te verbeteren is nauwere samenwerking tussen huisarts, longarts
en cardioloog nodig.

COPD-hart- en vaatziekten-hartfalen-onderzoek-ouderen

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