Abstract
AimsCreation of an algorithm that includes the most important parameters (history, clinical parameters, and anamnesis) that can be linked to heart failure, helping general practitioners in recognizing heart failure in an early stage and in a better follow-up of the patients.Methods and resultsThe algorithm was created using a consensus-based Delphi panel technique with fifteen general practitioners and seven cardiologists from Belgium. The method comprises three iterations with general statements on diagnosis, referral and treatment, and follow-up. Consensus was obtained for the majority of statements related to diagnosis, referral, and follow-up, whereas a lack of consensus was seen for treatment statements. Based on the statements with good and perfect consensus, an algorithm for general practitioners was assembled, helping them in diagnoses and follow-up of heart failure patients. The diagnosis should be based on three essential pillars, i.e. medical history, anamnesis and clinical examination. In case of suspected heart failure, blood analysis, including the measurement of NT-proBNP levels, can already be performed by the general practitioner followed by referral to the cardiologist who is then responsible for proper diagnosis and initiation of treatment. Afterwards, a multidisciplinary health care process between the cardiologist and the general practitioner is crucial with an important role for the general practitioner who has a key role in the up-titration of heart failure medication, down-titration of the dose of diuretics and to assure drug compliance.ConclusionsBased on the consensus levels of statements in a Delphi panel setting, an algorithm is created to help general practitioners in the diagnosis and follow-up of heart failure patients.
Highlights
Heart failure (HF) is a complex syndrome that is characterized by clinical manifestations, such as breathlessness, ankle swelling, and fatigue and typically accompanied by signs, such as elevated jugular venous pressure, pulmonary crackles and peripheral edema
In case of suspected heart failure, blood analysis, including the measurement of NT-proBNP levels, can already be performed by the general practitioner followed by referral to the cardiologist who is responsible for proper diagnosis and initiation of treatment
The first round has been completed in the respected timeframe of 2 weeks by 6 (86%) of the cardiologists and by 14 (93%) of the general practitioners (GPs)
Summary
Heart failure (HF) is a complex syndrome that is characterized by clinical manifestations, such as breathlessness, ankle swelling, and fatigue and typically accompanied by signs, such as elevated jugular venous pressure, pulmonary crackles and peripheral edema. These symptoms and signs are caused by structural and functional impairments resulting in reduced cardiac output or elevated ventricular filling pressure at rest or during stress [1]. Data from registries currently demonstrates 1–2% prevalence of HF that increases to 10% and more in people aged 70 and over. It was calculated that the healthcare cost for HF patients accounts for 1–3% of the total healthcare expenditure in North and Latin America, as well as in Europe [2]
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