Validity of clinical diagnosis of heart failure in primary health care

Abstract

Validity of heart failure (HF) diagnosis was studied in 88 patients (37 men and 51 women), aged 45-74 (mean 61) years, in whom HF diagnosis had been newly made by primary health care physicians. Boston criteria for HF and a supplementary classification, based on information from clinical examinations and a 6-month follow-up, were used to define HF diagnosis as 'definite', 'possible' or 'unlikely'. Twenty-eight (32%) patients (21 men and seven women) had 'definite' HF and 46 (52%) (28 men and 18 women) had either 'definite' or 'possible' HF by both classifications. In 30 (34%) patients (six men and 24 women) HF diagnosis was 'unlikely' by both classifications. In conclusion, false-positive diagnosis of HF was common in primary health care, and HF diagnosis was more difficult in women than in men. Obesity, unrecognized symptomatic myocardial ischaemia without HF and pulmonary diseases were the most important conditions leading to false-positive HF diagnosis.

Determinants and Prognostic Impact of Heart Failure Complicating Acute Coronary Syndromes

“…5,18 In GRACE, HF at admission was assessed by clinical examination, which has limitations in the acute setting, as symptoms may be nonspecific and physical examination may lack sensitivity. 19,20 Indeed, there may be underrepresentation of patients with atypical symptoms in GRACE, especially when the presenting symptoms are re- lated to HF. However, such low sensitivity would be expected to underestimate the prevalence of HF among patients with ACS and therefore does not detract from our finding of the ominous prognostic implications of HF.…”

Can brain natriuretic peptide (BNP) be used as a screening tool in general practice?

“…The validity of a diagnosis of chronic heart failure in primary care is poor (6,8,9). There is no access to UCG in primary care, which is why the diagnosis of heart failure must be settled clinically and in combination with available laboratory tests.…”

Keeping the culture alive: the laboratory technician in mid-twentieth-century British medical research

“…Studies that have explored the validity of a diagnostic label of heart failure in primary care, report high rates of misdiagnosis when patients are assessed against objective criteria, with rates of accuracy quoted of 50%, 9 25%, 10 and 32%. 11 In only 26% of patients referred to a rapid access heart failure clinic with suspected heart failure was the diagnosis established after investigation. 12 However, these data, on low rates of confirmed heart failure among patients with a diagnostic label, provide only a partial picture.…”