Key result
Hospital-based management for suspected HF linked to ~86% ACEi/ARB use at one year.
Why the study?
Does a hospital-based specialist management programme improve diagnosis and treatment optimization in primary care patients with suspected new onset heart failure?
Observational (n=102)
Does a hospital-based specialist management programme improve diagnosis and treatment optimization in primary care patients with suspected new onset heart failure?
p-value: p=< 0.001
A cooperative management program between primary care and cardiology specialists successfully improves diagnostic accuracy and guideline-directed medical therapy optimization for new-onset heart failure.
Supports specialist-primary care HF programs; leaves open whether RCTs confirm outcome benefits.
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.
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Mejhert et al. (2014) conducted an observational in Suspected new onset congestive heart failure (CHF) (n=102). Hospital-based cardiology outpatient clinic management programme was evaluated on Increase in ACE-inhibitors/angiotensin receptor blockers from baseline at one year (p=< 0.001). A hospital-based management program for suspected heart failure confirmed the diagnosis in 47% of patients and increased ACE-inhibitor/ARB use to 86% at 1 year (P<0.001).
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