Clinical diagnosis of heart failure by primary care physicians was frequently false-positive, with 34% of newly diagnosed patients classified as 'unlikely' to have heart failure by standard criteria.
Observational (n=88)
How valid is the clinical diagnosis of heart failure made by primary health care physicians compared to standardized criteria?
False-positive diagnosis of heart failure is common in primary care, particularly in women, and is often confounded by obesity, unrecognized myocardial ischemia, and pulmonary diseases.
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.
Remes et al. (金曜日) は心不全に関する観察研究を実施しました（n=88）。プライマリケア医による臨床診断とボストン基準及び補足分類が心不全診断の妥当性（「確定」、「可能性あり」、「あり得ない」）について評価されました。プライマリケア医による心不全の臨床診断は、しばしば誤って陽性であり、新たに診断された患者の34%が標準基準によって「心不全である可能性が低い」と分類されました。