Cardiac-related symptoms in individuals aged ≥65 years without diagnosed cardiac disease: insights from the NORSCREEN trial

Population-based data on cardiac-related symptoms in individuals without diagnosed cardiac disease remain limited, despite important implications for early detection and management. We aimed to assess the prevalence of self-reported symptoms and the association with quality of life (QoL) among adults aged ≥65 years with ≥1 additional stroke risk factor, but without diagnosed cardiac disease.

This is a cross-sectional study of the NORwegian atrial fibrillation self-SCREENing (NORSCREEN) trial population at baseline. NORSCREEN is an ongoing, nationwide, randomized atrial fibrillation screening study in adults aged ≥65 years at increased risk of stroke (CHA₂DS_2-VA ≥2). All participants completed a baseline questionnaire capturing clinical information, symptoms, and QoL. Of the 50 549 participants enrolled from 2023 to 2025, 39 281 (78%) reported no diagnosed cardiac disease. Among those, 17 069 (43%) reported cardiac-related symptoms compared to 7551 (67%) of 11 268 individuals with known cardiac disease. The most common symptoms were fatigue, exertional dyspnoea, and tachycardia. Female sex [adjusted odds ratio 1.66, (95% CI 1.58–1.75)], physical inactivity [1.43 (1.32–1.55)], current smoking [1.24 (1.12–1.37)], age <75 years [1.14 (1.08–1.20)], living alone [1.13 (1.07–1.20)], and comorbidities including chronic obstructive pulmonary disease [6.51 (5.63–7.54)] and anxiety [3.99 (3.64–4.38)] were associated with cardiac-related symptoms. Symptomatic individuals reported significantly lower RAND-36 QoL scores across all domains compared to those without symptoms.

In this cohort of individuals aged ≥65 years at increased risk of stroke, but without diagnosed cardiac disease, nearly half reported cardiac-related symptoms, which were associated with substantially reduced QoL. These findings suggest there might be unmet needs in identifying and managing cardiovascular disease.

Registration: Clinical trials: NCT05914883