Clinical Review ABC of heart failure

Heart failure in general practice

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7235.626 (Published 04 March 2000) Cite this as: BMJ 2000;320:626
  1. F D R Hobbs,
  2. R C Davis,
  3. G Y H Lip

    Management of heart failure in general practice has been hampered by difficulties in diagnosing the condition and by perceived difficulties in starting and monitoring treatment in the community. Nevertheless, improved access to diagnostic testing and increased confidence in the safety of treatment should help to improve the primary care management of heart failure. With improved survival and reduced admission rates (achieved by effective treatment) and a reduction in numbers of hospital beds, the community management of heart failure is likely to become increasingly important and the role of general practitioners even more crucial.

    Heart failure affects at least 20 patients on the average general practitioner's list

    Diagnostic algorithm for suspected heart failure in primary care. Based on guidance from the north of England evidence based guideline development project (see key references box)

    Diagnostic accuracy

    Heart failure is a difficult condition to diagnose clinically, and hence many patients thought to have heart failure by their general practitioners may not have any demonstrable abnormality of cardiac function on objective testing.

    A study from Finland reported that only 32% of patients suspected of having heart failure by primary care doctors had definite heart failure (as determined by a clinical and radiographic scoring system). A recent study in the United Kingdom showed that only 29% of 122 patients referred to a “rapid access” clinic with a new diagnosis of heart failure fully met the definition of heart failure approved by the European Society of Cardiology—that is, appropriate symptoms, objective evidence of cardiac dysfunction, and response to treatment if doubt remained.

    Similar findings have been reported in the echocardiographic heart of England screening (ECHOES) study, in which only about 22% of the patients with a diagnosis of heart failure in their general practice records had definite impairment of left ventricular systolic function on echocardiography, with a further …

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