Key result
Primary care heart failure investigation lags guideline targets, taking a median ~292 days from symptoms.
Why the study?
Clinical guidelines on heart failure recommend timings for primary care investigation and referral, but the actual time required for patients to achieve key elements of the diagnostic pathway was unknown.
Observational (n=8,913)
Yes
There are significant and prolonged delays in primary care for investigating, referring, and diagnosing patients presenting with symptoms suggestive of heart failure, exceeding guideline recommendations.
Primary care HF symptom delays exceed guidelines; leaves open whether targeted interventions shorten time to diagnosis.
OBJECTIVE: Clinical guidelines on heart failure (HF) suggest timings for investigation and referral in primary care. We calculated the time for patients to achieve key elements in the recommended pathway to diagnosis of HF. METHODS: In this observational study, we used linked primary and secondary care data (Clinical Practice Research Datalink, a database of anonymised electronic records from UK general practices) between 2010 and 2013. Records were examined for presenting symptoms (breathlessness, fatigue, ankle swelling) and key elements of the National Institute for Health and Care Excellence-recommended pathway to diagnosis (serum natriuretic peptide (NP) test, echocardiography, specialist referral). RESULTS: 42 403 patients were diagnosed with HF, of whom 16 597 presented in primary care with suggestive symptoms. 6464 (39%) had recorded NP or echocardiography, and 6043 (36%) specialist referral. Median time from recorded symptom(s) to investigation (NP or echocardiography) was 292 days (IQR 34-844) and to referral 236 days (IQR 42-721). Median time from symptom(s) to diagnosis was 972 days (IQR 337-1468) and to treatment with HF-relevant medication 803 days (IQR 230-1364). Factors significantly affecting timing of referral, treatment and diagnosis included patients' sex (p=0.001), age (p<0.001), deprivation score (p=0.001), comorbidities (p<0.001) and presenting symptom type (p<0.001). CONCLUSIONS: Median times to investigation or referral of patients presenting in primary care with symptoms suggestive of HF considerably exceeded recommendations. There is a need to support clinicians in the diagnosis of HF in primary care, with improved access to investigation and specialist assessment to support timely management.
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Hayhoe et al. (2018) conducted an observational in Heart failure (n=8,913). Presentation with symptoms suggestive of heart failure was evaluated on Median time from recorded symptom(s) to investigation (serum natriuretic peptide test or echocardiography). In primary care, median time from recorded heart failure symptoms to investigation or referral was 292 days and 236 days respectively, considerably exceeding guideline recommendations.
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