Devroey D, Van Casteren V. Signs for early diagnosis of heart failure in primary health care. Vasc Health Risk Manag. 2011;7:591-6.
Eerste auteur: Devroey D.
Jaar: 2011
Type: Publicatie
Medline
Vasc Health Risk Manag
Abstract:
OBJECTIVE: Only few reliable data about the diagnosis of heart failure (HF) in primary health care exist. The aim of this study is to describe the symptoms, clinical signs and diagnostic procedures confirming the diagnosis of HF in primary health care.
MATERIAL / SUBJECTS AND METHODS: Data were prospectively collected during a two-year period by a nationwide network of sentinel practices. All adult patients without known HF for whom the first time the diagnosis of HF was clinically suspected were registered. The final diagnosis of HF was confirmed after one month.
RESULTS: 754 patients with a suspicion of HF were recorded. The diagnosis of HF was confirmed for 74% of patients. The median age of the patients with confirmed HF was 77.7 years and for those without HF 75.6 years (p=0.018). From a logistic regression breathlessness on exercise (p<0.001), limitations of physical activity (p=0.003) and orthopnoea (p=0.040) were the symptoms with the highest association with HF. The clinical signs with the highest association with HF were pulmonary rales (p<0.001), peripheral edema (p<0.001) and raised jugular venous pressure (p=0.039). An electrocardiogram was performed in 75% of the patients, a blood analyses in 68%, an echocardiogram in 63%, a chest X-ray in 61% and determination of natriuretic peptides in 11%.
CONCLUSION: Many clinical signs may appear among patients with HF. However, the occurrence of peripheral edema or breathlessness on exercise or pulmonary rales are highly suggestive for HF. The diagnosis of HF was often not confirmed by an echocardiogram and/or an electrocardiogram.
Trefwoorden: Heart Failure; Primary Health Care; Diagnostic Clinical Signs