Mejhert Märit, Kahan Thomas
Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine , Stockholm , Sweden.
Eur J Gen Pract. 2015 Mar;21(1):26-32. doi: 10.3109/13814788.2014.908282. Epub 2014 Oct 24.
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.
To describe a management programme for patients with suspected CHF in primary care in cooperation with specialists in cardiology.
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.
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.
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.
新发充血性心力衰竭（CHF）的诊断通常较为困难，因为其症状和体征缺乏特异性。在初级医疗保健中，适当的诊断检查和治疗未得到充分利用。
描述一项在初级医疗保健中与心脏病专家合作，针对疑似CHF患者的管理方案。
对102例连续转诊至一家易于就诊的医院心脏病门诊管理方案的疑似新发CHF初级医疗保健患者进行前瞻性研究。经过临床检查、心电图、超声心动图、包括NT-proBNP在内的血液生化检查，以及纽约心脏协会（NYHA）心功能分级和生活质量（EQ5D）评估后，确诊为CHF的患者被开具药物，并得到关于滴定和目标剂量的建议。经过培训的CHF护士提供有关CHF的信息并进行随访。
转诊患者中有一半（47%）被确诊为CHF。低NT-proBNP值（<300 ng/l）的阴性预测值为73%。呼吸道疾病是常见的鉴别诊断。在随访一年时，CHF组使用的药物中，86%为血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂，61%为β受体阻滞剂，81%为利尿剂（血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂从基线水平增加，P<0.001）。NYHA心功能分级从基线（中位数2，范围：1 - 3）改善至一年时（P<0.05），而NT-proBNP（1491 - 1261 ng/l）和生活质量（EQ5D；67 - 67）未发生变化。
一项在初级医疗保健中优化疑似新发CHF患者护理质量、并转诊至医院专科团队的管理方案可以成功应用。
