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 …