Prevalence of Cardiovascular Disease in Older Nursing Home Residents

Wilbert S. Aronow, MD, CMD
Department of Medicine,
Divisions of Cardiology and Geriatrics,
Westchester Medical Center/New York Medical College,
Valhalla, NY.

Cardiovascular disease (CVD) is the most common cause of death of older persons in a nursing home (NH). In a prospective study, we investigated the major clinical cause of death of all persons aged 60 years and older residing in a large NH with full-time staff physicians over a 15-year period.¹

CVD was the cause of death in 63% of the 2,372 persons who died. Another 25 persons (1%) died of bacterial endocarditis. Of the 2,372 persons who died, 25% died of sudden cardiac death, 18% died of a documented fatal myocardial infarction, 11% died of refractory congestive heart failure, 6% died of thromboembolic stroke, 1% died of cerebral hemorrhage, 2% died of pulmonary embolism, 1% died of mesenteric vascular infarction diagnosed at surgery, and <1% died of peripheral vascular disease including dissecting aneurysm of the aorta and ruptured abdominal aneurysm.¹

In a prospective study, we investigated the prevalence and incidence of CVD in 1,160 men, mean age 80 years, and in 2,464 women, mean age 81 years, residing in a NH.² Of the 3,624 persons, 60% were white, 26% African-American, 14% Hispanic, and <1% Asian. Follow-up was 46 months (range 1 to 196 months).²

Hypertension was present in 57% of men (37% with isolated systolic hypertension and 20% with systolic and diastolic hypertension) and in 60% of women (39% with isolated systolic hypertension and 21% with systolic and diastolic hypertension).^2,3

The prevalence of chronic atrial fibrillation was significantly higher in men (16%) than in women (13%).² A pacemaker rhythm was present in 5% of men and 5% of women.²

The prevalence of coronary artery disease (CAD) was 43% in men and 41% in women.² The incidence of new coronary events was 46% in men and 44% in women.² The prevalence of peripheral arterial disease was significantly higher in men (32%) than in women (26%).²

The prevalence of thromboembolic stroke was 32% in men and 31% in women.² The incidence of new thromboembolic stroke was 23% in men and 21% in women.² The incidence of congestive heart failure was 29% in men and 26% in women.² The prevalence of CVD was 85% in men and 84% in women.²

In 17% of 555 men residing in a NH, 40-100% extracranial carotid arterial disease, diagnosed by bilateral carotid duplex ultrasonography, was present; extracranial CAD was present in 14% of 1,291 women.⁴ Two percent of 976 elderly NH patients developed bacterial endocarditis during 39 months of follow-up.⁵

We also performed a prospective study investigating the prevalence of abnormalities diagnosed by ECG in 924 men, mean age 80 years, and in 1,881 women, mean age 81 years, residing in a NH.⁶ The prevalence of rheumatic mitral stenosis was significantly higher in women (2%) than in men (0.3%).⁶ The prevalence of mitral annular calcification was significantly higher in women (52%) than in men (36%).⁵ The prevalence of = 1+ mitral regurgitation was 33% in women and 32% in men.⁶ The prevalence of = 1+ aortic regurgitation was 31% in men and 29% in women.⁶ The prevalence of valvular aortic stenosis was 17% in women and 15% in men.⁶ The prevalence of hypertrophic cardiomyopathy was 4% in women and 3% in men.⁶ The prevalence of idiopathic dilated cardiomyopathy was 1% in women and 1% in men.⁶ The prevalence of left atrial enlargement was significantly larger in women (38%) than in men (30%).⁶ The prevalence of left ventricular hypertrophy was 44% in women and 43% in men.⁶ The prevalence of abnormal left ventricular ejection fraction (<50%) was significantly higher in men (29%) than in women (22%).⁶

Thus, the above data demonstrate the very common prevalence of several CVDs in older people in nursing homes. Not surprisingly, CVD remains the leading cause of morbidity and mortality in older patients in NHs.

The following series is designed to help prevent and manage cardiovascular disease in elderly nursing home patients. This first part of the series contains articles on stable coronary artery disease, congestive heart failure and bacterial endocarditis. Look for the second part of this series in a future issue of Geriatrics & Aging.

References

1. Aronow WS. J Am Med Dir Assoc 2000;1:95-96.
2. 1997 Joint National Committee. The Sixth Report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Arch Intern Med 1997;157:2413-44.
3. Aronow WS, Ahn C, Gutstein H. J Gerontol: Medical Sciences 2001;56A:
4. Aronow WS, Ahn C, Schoenfeld MR, Gutstein H. Am J Cardiol 1999;83:1403-4.
5. Aronow WS, Koenigsberg M, Kronzon I, Gutstein H. Am J Cardiol 1990; 65:1511-2.
6. Aronow WS, Ahn C, Kronzon I. Am J Cardiol 2001;87:1131-3.