A management programme for suspected heart failure in primary care in cooperation with specialists in cardiology

Abstract

Background: The diagnosis of new onset congestive heart failure (CHF) is often difficult as symptoms and signs are non-specific. Proper diagnostic investigations and treatments are underused in primary care.

Objective: To describe a management programme for patients with suspected CHF in primary care in cooperation with specialists in cardiology.

Methods: Prospective study of 102 consecutive primary care patients with suspected new onset CHF referred to an easily accessible hospital-based cardiology outpatient clinic management programme. Following clinical examination, ECG, echocardiography, blood chemistry including NT-proBNP, and assessment of NYHA class and quality of life (EQ5D), patients with a confirmed diagnosis of CHF were prescribed medication with advice on titration and target doses. Trained CHF nurses gave Information on CHF and provided follow up.

Results: Half (47%) of the referred patients had the diagnosis of CHF confirmed. Low NT-proBNP values (< 300 ng/l) provided a negative predictive value of 73%. Respiratory tract diseases were common differential diagnoses. At one year of follow-up, medication in the CHF group was 86% ACE-inhibitors/angiotensin receptor blockers, 61% ß-blocking agents, and 81% diuretics (P < 0.001 for the increase in ACE-inhibitors/angiotensin receptor blockers from baseline). NYHA class improved from baseline (median 2, range: 1–3) to one year (P < 0.05), whereas NT-proBNP (1491–1261 ng/l), and quality of life (EQ5D; 67–67) were unchanged.

Conclusion: A management programme to optimize quality of care for patients with suspected new onset CHF in primary care, with referral to a hospital-based specialist team, can be applied successfully.

Keywords::

• Heart failure
• primary health care
• management programme
• natriuretic peptides

FUNDING

Supported by the Regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet; the Tornspiran Foundation; the Swedish Association of Local Authorities and Regions; and Karolinska Institutet Research Foundations. AstraZeneca, Mölndal, Sweden, and Roche Diagnostics Scandinavia, Stockholm, Sweden, supported part of the costs for analyses of NT-proBNP.

ACKNOWLEDGEMENT

The authors acknowledge the expert advice and support from Dr Björn Eriksson, Gustavsberg primary care centre, and all collaborating primary care physicians.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.