Früherkennung der Herzinsuffizienz beim älteren Menschen - Schlechte Prognose macht Screening empfehlenswert

Bei der Herzinsuffizienz handelt es sich um ein häufiges, klinisch bedeutsames und therapierbares Krankheitsbild in der Allgemeinpraxis. Zu den anerkannten Risikogruppen für Herzinsuffizienz gehören Patienten mit Hypertonie und koronarer Herzkrankheit, Klappenfehlern und anderen kardialen Vorerkrankungen. In der Hausarztpraxis kommt eine Herzinsuffizienz vor allem bei älteren Patienten vor, speziell bei über 75-Jährigen und Patienten mit Zustand nach Myokardinfarkt, Diabetes mellitus, koronarer Herzkrankheit und Hypertonie. Die Diagnose einer Herzinsuffizienz sollte frühzeitig gestellt werden, da bereits bei asymptomatischen Patienten mit eingeschränkter linksventrikulärer Funktion eine Therapie die Prognose bessert. Allein anhand der klassischen Anamnese und Befunde lässt sich die Diagnose nicht mit ausreichender Sicherheit stellen oder ausschließen. Daher wird empfohlen, Risikogruppen während der üblichen Vorsorgeuntersuchungen regelmäßig nach Atemnot oder abnormer Müdigkeit zu befragen und auf das EKG zu achten. Da ein normales 12-Kanal-EKG eine Herzinsuffizienz unwahrscheinlich macht, sind vor allem ältere Patienten mit pathologischem EKG Kandidaten für eine frühzeitige echokardiographische Untersuchung. Wegen der hohen Kosten des Labortests (BNP) und der nicht ausreichenden Evidenz muss hier die weitere Entwicklung bezüglich der Ergebnisse neuerer Studien und sozialrechtlicher Fragen abgewartet werden.

Heart failure is a common major clinical problem in general practice. Recognized risk groups for heart failure include patients with hypertension and coronary artery disease, heart valve disease and other cardiac conditions. In general practice, heart failure is seen in particular in the elderly patient, especially in over-75-year-olds and patients after a myocardial infarction, diabetes mellitus, coronary artery disease or hypertension. The diagnosis should be established as early as possible, since asymptomatic patients with reduced ventricular function respond to treatment with an improved prognosis. The diagnosis cannot be established or excluded with sufficient certainty on the basis of the classical history and findings alone. It is therefore recommended that during the usual screening examination risk groups should regularly be questioned about breathlessness or unusual fatigue, and attention be given to the ECGH. Since a normal 12-lead ECG makes heart failure unlikely, in particular elderly patients with a pathological ECG are candidates for an early echocardiographic examination. The expense of laboratory tests (BNP) and lack of evidence make it necessary to await the results of more recent studies and the answers to sociolegal questions.

Key Words

cardiac insufficiency - NYHA stage - family doctor practice - ECG screening - elderly patients

Literatur

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