The electrocardiogram in the elderly : diagnostic and prognostic studies

In most developed countries the proportion of elderly people in the population is expected to increase in the next decades. Cardiovascular disease is a leading cause of death and disability in the elderly and it is predicted that the absolute incidence rates of cardiac disease in older adults will increase significantly in the years to come. Since the invention of electrocardiography in 1902 by Willem Einthoven, the electrocardiogram (ECG) has gained an important position in clinical cardiology. In the last decade, computer programs for ECG interpretation with good pelformance have become available , improving the applicability of ECGs in medical practice and in epidemiologic research. The EeG offers an inexpensive. noninvasive instrument to determine the presence of coronmy hemt disease as well as other cardiae abnormalities, such as ventricular hypertrophy and atrial fibrillation, known to be associated with the risk of future cardiovascular events. Especially in the elderly, in whom medical histories may be troubled by concomitant diseases and are not always as reliable as one would desire, the ECG could serve as a useful diagnostic and prognostic instrument. Since the 1950s, large epidemiologic studies among young and middle-aged men and women have provided important information on the prevalence and prognosis of ECG abnormalities. Relatively few studies have been pelfonned in the elderly. A comparison of individual studies is hampered because of differences in diagnostic criteria applied in the individual studies, although comparability has improved since the introduction in 1960 of the Minnesota Code as a standardized coding system for the ECG. Recently, several studies reported that ECG indicators of autonomic balance, such as heart rate variability and QTc interval duration, may be strong predictors of cardiac and all-cause mortality, both in middle-aged and in older subjects.

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