Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
Leidsche Rijn Julius Healthcare Centers, Utrecht, The Netherlands.
BMC Prim Care. 2024 Jun 14;25(1):216. doi: 10.1186/s12875-024-02466-6.
General practitioners (GPs) specialized in cardiovascular disease (GPSI-CVD) may suspect heart failure (HF) more easily than GPs not specialized in CVD. We assessed whether GPSI-CVD consider investigations aimed at detecting HF more often than other GPs in two clinical scenarios of an older male person with respiratory and suggestive HF symptoms.
In this vignette study, Dutch GPs evaluated two vignettes. The first involved a 72-year-old man with hypertension and a 30 pack-year smoking history who presented himself with symptoms of a common cold, but also shortness of breath, reduced exercise tolerance, and signs of fluid overload. The second vignette was similar but now the 72-year-old man was known with chronic obstructive pulmonary disease (COPD). GPs could select diagnostic tests from a multiple-choice list with answer options targeted at HF, COPD or exacerbation of COPD, or lower respiratory tract infection. With Pearson Chi-square or Fisher's exact test differences between the two GP groups were assessed regarding the chosen diagnostic tests.
Of the 148 participating GPs, 25 were GPSI-CVD and 123 were other GPs. In the first vignette, GPSI-CVD more often considered performing electrocardiography (ECG) than other GPs (64.0% vs. 32.5%, p = 0.003). In the second vignette, GPSI-CVD were more inclined to perform both ECG (36.0% vs. 12.2%, p = 0.003) and natriuretic peptide testing (56.0% vs. 32.5%, p = 0.006).
Most GPs seemed to consider multiple diagnoses, including HF, with GPSI-CVD more likely performing ECG and natriuretic peptide testing in an older male person with both respiratory and suggestive HF symptoms.
心血管疾病专科医生（GPSI-CVD）比非心血管疾病专科医生更能轻易怀疑心力衰竭（HF）。我们评估了在有呼吸症状和疑似 HF 症状的老年男性的两种临床情况下，心血管疾病专科医生是否比其他全科医生更经常考虑进行旨在检测 HF 的检查。
在这项案例研究中，荷兰全科医生评估了两个案例。第一个涉及一名 72 岁的男性，有高血压病史和 30 包年吸烟史，他因感冒症状就诊，但也有呼吸急促、运动耐力降低和液体超负荷的迹象。第二个案例类似，但现在这位 72 岁的男性患有慢性阻塞性肺疾病（COPD）。全科医生可以从针对 HF、COPD 或 COPD 加重或下呼吸道感染的多选题列表中选择诊断测试。使用 Pearson Chi-square 或 Fisher's exact 检验评估了两组 GP 之间在所选诊断测试方面的差异。
在 148 名参与的全科医生中，25 名是心血管疾病专科医生，123 名是其他全科医生。在第一个案例中，心血管疾病专科医生比其他全科医生更经常考虑进行心电图（ECG）检查（64.0%比 32.5%，p = 0.003）。在第二个案例中，心血管疾病专科医生更倾向于进行心电图（36.0%比 12.2%，p = 0.003）和利钠肽检测（56.0%比 32.5%，p = 0.006）。
大多数全科医生似乎都考虑了多种诊断，包括 HF，心血管疾病专科医生更有可能对既有呼吸症状又有疑似 HF 症状的老年男性进行心电图和利钠肽检测。
