Can heart failure be diagnosed in primary care?

Brain natriuretic peptide assays may make it easier

Papers p 215

Heart failure is an increasingly important problem for primary care physicians in most healthcare systems in developed countries. The condition is almost as common as diabetes mellitus in older adults, occurring in at least 2% of the adult population and rising to 3% in those aged over 75 years. 1 2 Although the incidence of most cardiovascular diseases has declined over the past 20 years, the incidence of heart failure has continued to rise, due in part to the fact that more people are surviving after acute myocardial infarctions and also to the increasing number of elderly people.3

Symptomatic heart failure has a major impact on patients and healthcare systems: it has a worse prognosis than breast cancer or prostate cancer and is second only to stroke in terms of healthcare costs.4 Heart failure costs the United States over $8bn (£5bn) each year, and 5% of all admissions in the United Kingdom involve some degree of heart failure.5 In addition to high mortality, patients with heart failure also have morbidity from symptoms such as dyspnoea and fatigue.6

Accurate and early diagnosis is important since angiotensin converting enzyme inhibitors improve both morbidity and mortality …