Triage of reduced exercise tolerance in frail elderly

Many elderly suffer from reduced exercise tolerance or exercise induced
shortness of breath (dyspnoea) which causes decreased mobility and restrictions
in physical, psychological and social functioning. Patients commonly attribute
this symptom to their age, and simply adjust their life style to it. Reduced
exercise tolerance/dyspnoe is very common with prevelance rate of 20-60% of
those aged 65 years and over. The main causus in the elderly are heart failure
and chronic obstructive pulmonary disease (COPD). Both diseases have a high
negative impact on the quality of life and are associated with frequent
hospital admissions. Over-diagnosis, but more often under-diagnosis of heart
failure and COPD is rather common in primary care. Establishing a diagnosis
early in the course of the disease is useful because both diseases can be
adequately and evidence-based treated. Therefore, an easy diagnostic
triage-strategy followed bij direct treatment would be of great importance to
asses and treat heart failure and COPD in elderly patient with shortness of
breath.

Quantify how many frail elderly aged over 65 years with reduced exercise
tolerance and/or exercise induced dyspnoea have previously unrecognised COPD
and heart failure.
Quantify the difference in prevalence of unrecognised COPD and heart failure
between those who underwent the diagnostic triage compared to those who
received care as usual.
Quantify the effect of the diagnostic triage plus the additionally treatment
changes on functionality and quality of life after 6 months compared to those
who received care as usual.
Quantify the cost-effectiveness of the diagnostic triage strategy compared to
care as usual

A clustered randomized diagnostic (follow-up) study

There is no risk associated with participation. Echocardiographic measurements
with radio frequency waves, electrocardiographic measurements and spirometric
measurements can be performed without risk. The major disadvantage for the
patients, in both groups, is the time investment. All participants fill out 3
different questionnaires on the start of the project and after 6 months.
Participants in the index group undergo standardised history taking, physical
examination, blood test, ECG, spirometry and echocardiography, which take all
place in the primary care setting.
The advantages are that, when proven to be clinically effective, the
triage-treatment approach can simply be used to detect and treat latent COPD
and heart failure. In the future, a large number of frail elderly with (some
kind of) shortness of breath will be more timely treated with adequate
management improving the patient*s functionality, health related quality of
life and likely decreases morbidity and mortality. Direct implementation of
this instrument in all general practices in the Netherlands or even abroad
seems feasible.