Heart Failure Diagnoses in Primary Care: Can we Help the Queries?

Abstract

Background: Heart Failure (HF) can be difficult to diagnose and guidelines recommend echocardiography (echo) early in the assessment of suspected or confirmed HF. However echo access in NZ is limited and often delayed. Early diagnosis assists timely and appropriate treatment and facilitates referral for other investigation and treatment. Aims: To assess the diagnostic accuracy of patients with a HF diagnosis in primary care and to assist with appropriate investigation and management of these patients. This pilot study seeks to extend the role of the community based Waikato Integrated HF service (WIHFS) into primary care and provide education within general practice. Methods: Within 2 group GP practices, a “Query Build” search of patient databases for patients with HF diagnosis. Chart reviews were undertaken to assess for evidence of fulfillment of diagnostic criteria. (Patients already assessed by the cardiology service were excluded). Patients with a likely diagnosis of HF were further assessed by the WIHFS with most having an echo. Results: 104/156 (67%) of GP-diagnosed HF patients were considered to have HF (confirmed or likely) on chart review Of the HF likely patients further assessed, 23/33 (70%) had HF diagnosis confirmed. Overall, only 94/156 (60%) of HF labelled patients in primary care were considered to be accurately diagnosed as HF. Conclusions: Access to a specialist HF service and echo can assist with diagnostic accuracy in primary care and reduce over-diagnosis, thereby assisting with appropriate management.