Shah S, Davies M K, Cartwright D, Nightingale P
Department of Cardiology, University Hospital Birmingham, Selly Oak Hospital, Birmingham, UK.
Heart. 2004 Jul;90(7):755-9. doi: 10.1136/hrt.2002.006460.
To evaluate the role of an open access heart failure service based at a teaching hospital for the diagnosis and treatment optimisation of patients with heart failure in the community and to identify measures that may further enhance the effectiveness of such a service.
963 patients with suspected heart failure seen over an eight year period referred by their general practitioners to the cardiology department at a district general hospital.
Presence or absence of left ventricular systolic dysfunction (LVSD) (left ventricular ejection fraction < 50% on echocardiography), and determination of the risk factors and predictors of LVSD.
The majority of the patients were women (60% v 40%) and elderly (mean age 68.8 years). On echocardiography, only 30.8% were found to have LVSD. Patients were more likely to have LVSD if they were men (42.3% v 23.1%, p < 0.001, relative risk (RR) 1.8), were > 60 years of age (33.5% v 20.8%, p < 0.001, RR 1.6), or had a history of diabetes (49.4% v 29.1%, p < 0.001, RR 1.7), ischaemic heart disease (36.5% v 29.1%, p = 0.04, RR 1.3), or atrial fibrillation (52.6% v 27.8%, p < 0.001, RR 1.9). An abnormal ECG (48.4% v 19.5%, p < 0.001, RR 2.5) and cardiothoracic ratio > 0.5 on chest radiograph (44.3% v 17.8%, p < 0.001, RR 2.5) were found to be good predictors of LVSD. A normal ECG (negative predictive value 80.5%) and a cardiothoracic ratio of < 0.5 (negative predictive value 82.2%) can be used as baseline measures to identify patients with lower risk of developing LVSD (combined negative predictive value 87.9%).
An open access heart failure clinic is effective for the diagnosis and management of chronic heart failure in community based patients. The presence of risk factors and simple baseline tests can be used to identify patients with LVSD in the community. The introduction of a protocol based on these findings into a referral system can improve the efficiency and cost effectiveness of such a service.
评估一家教学医院提供的开放式心力衰竭服务在社区心力衰竭患者诊断及优化治疗方面的作用，并确定可能进一步提高该服务有效性的措施。
963例疑似心力衰竭患者，这些患者在8年期间由其全科医生转诊至一家地区综合医院的心脏病科。
左心室收缩功能障碍（LVSD）（超声心动图显示左心室射血分数<50%）的有无，以及LVSD的危险因素和预测因素的判定。
大多数患者为女性（60%对40%）且年龄较大（平均年龄68.8岁）。超声心动图检查发现，只有30.8%的患者存在LVSD。男性患者（42.3%对23.1%，p<0.001，相对危险度（RR）1.8）、年龄>60岁（33.5%对20.8%，p<0.001，RR 1.6）、有糖尿病史（49.4%对29.1%，p<0.001，RR 1.7）、有缺血性心脏病史（36.5%对29.1%，p = 0.04，RR ）或心房颤动史（52.6%对27.8%，p<0.001，RR 1.9）的患者更易发生LVSD。心电图异常（48.4%对19.5%，p<0.001，RR 2.5）和胸部X线片心胸比率>0.5（44.3%对17.8%，p<0.001，RR 2.5）被发现是LVSD的良好预测指标。正常心电图（阴性预测值80.5%）和心胸比率<0.5（阴性预测值82.2%）可作为基线指标，用于识别发生LVSD风险较低的患者（联合阴性预测值87.9%）。
开放式心力衰竭门诊对于社区慢性心力衰竭患者的诊断和管理是有效的。危险因素的存在及简单的基线检查可用于在社区中识别LVSD患者。将基于这些发现的方案引入转诊系统可提高此类服务的效率和成本效益。
