Khunti K, Baker R, Grimshaw G
Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital.
Br J Gen Pract. 2000 Jan;50(450):50-4.
Chronic heart failure is a common clinical syndrome that may have different causes. Its incidence and prevalence are predicted to rise substantially over the next 10 years. There are therefore major consequences for resource provision, especially in primary care, where most patients are managed. Chronic heart failure is a serious condition with high morbidity and mortality. There is good evidence to show that treatment with angiotensin-converting enzyme (ACE) inhibitors in patients with left ventricular systolic dysfunction improves symptoms and signs, slows progression of heart failure, reduces hospitalisation rates, and improves survival. Despite this evidence, primary care studies show that patients with heart failure are incorrectly diagnosed and inadequately treated. Most patients present in general practice, and because effective treatment relies on a correct diagnosis, this is a key step in the appropriate management of heart failure. The aim of this paper is to review the evidence about the usefulness of signs, symptoms, and investigations in diagnosing heart failure in primary care. To identify relevant studies for this review, four strategies were used: a MEDLINE search from 1993 to January 1998 using the diagnosis search filter; a MEDLINE search from 1993 to January 1998 using the guideline search filter to locate published heart failure guidelines; a search for review articles in the Cochrane Library; and a check of references in the studies identified. The search terms included MeSH terms and the keywords 'heart failure' and 'diagnosis'. All searches were limited to humans and English language articles. Studies were included in this review on the basis of quality and relevance to primary care. The review shows that symptoms and signs are important because they alert clinicians to the possibility of heart failure as a diagnosis. However, they are not sufficiently specific for confirming left ventricular systolic dysfunction. From the evidence available, a patient with suspected heart failure must have objective tests to confirm the diagnosis. These should include an electrocardiogram and, ideally, an echocardiogram. Further research is also needed on the usefulness of signs and symptoms in primary care, as most studies of heart failure have been conducted in secondary care.
慢性心力衰竭是一种常见的临床综合征，病因可能多种多样。预计在未来10年其发病率和患病率将大幅上升。因此，这对资源配置，尤其是在管理大多数患者的初级保健领域，会产生重大影响。慢性心力衰竭是一种严重疾病，发病率和死亡率都很高。有充分证据表明，对左心室收缩功能障碍患者使用血管紧张素转换酶（ACE）抑制剂进行治疗可改善症状和体征，减缓心力衰竭进展，降低住院率，并提高生存率。尽管有这些证据，但初级保健研究表明，心力衰竭患者存在误诊和治疗不充分的情况。大多数患者在全科医疗中就诊，由于有效治疗依赖于正确诊断，所以这是心力衰竭合理管理的关键步骤。本文旨在综述有关体征、症状及检查在初级保健中诊断心力衰竭的有用性的证据。为确定本综述的相关研究，采用了四种策略：使用诊断检索过滤器对1993年至1998年1月的MEDLINE进行检索；使用指南检索过滤器对1993年至1998年1月的MEDLINE进行检索，以查找已发表的心力衰竭指南；在考克兰图书馆中搜索综述文章；以及检查所确定研究中的参考文献。检索词包括医学主题词以及关键词“心力衰竭”和“诊断”。所有检索仅限于人类和英文文章。基于质量和与初级保健的相关性，研究被纳入本综述。该综述表明，症状和体征很重要，因为它们使临床医生警觉到心力衰竭作为一种诊断的可能性。然而，它们对于确诊左心室收缩功能障碍的特异性不足。根据现有证据，疑似心力衰竭的患者必须进行客观检查以确诊。这些检查应包括心电图，理想情况下还应包括超声心动图。由于大多数心力衰竭研究是在二级保健中进行的，因此还需要对体征和症状在初级保健中的有用性进行进一步研究。
