The diagnosis of heart failure in primary care: value of symptoms and signs
- 1 October 2004
- journal article
- Published by Wiley in European Journal of Heart Failure
- Vol. 6 (6), 795-800
- https://doi.org/10.1016/j.ejheart.2004.08.002
Abstract
The value of symptoms and signs in the diagnosis of CHF has rarely been tested in large numbers of patients in the community. The aim of this study was to evaluate the importance of symptoms, signs, and past medical history in the diagnosis of CHF in primary care. Data on a sample of Portuguese men and women attending 365 primary care centres for any condition other than the treatment of acute infection, metabolic conditions or pregnancy were collected. All subjects who scored three or more points in the sum of categories one and two of the Boston questionnaire (history and physical examination) and those being treated for heart failure with loop or thiazide diuretics were considered to have possible heart failure and referred for further assessment including a resting echocardiogram. The sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio (LR) for the diagnosis of heart failure were calculated. A total of 5434 subjects were identified, of whom 1058 fulfilled the criteria for further assessment; 551 subjects had cardiac dysfunction at rest, of which 35.5% were in NYHA class I and 4.9% in class IV. Prior use of digoxin (LR 24.9) and/or diuretics (LR 10.6), a history of coronary artery disease (LR 7.1) or of pulmonary oedema (LR 54.2), were associated with a greater likelihood of having heart failure. Amongst current symptoms, a history of paroxysmal nocturnal dyspnoea (LR 35.5), orthopnea (LR 39.1) and breathlessness when walking on the flat (LR 25.8) were associated with a diagnosis of heart failure. However, these symptoms were not frequent amongst patients with heart failure within this population (sensitivity 6 cm with hepatic enlargement, and oedema of the lower limbs (LR 130.3), a ventricular gallop (LR 30.0), a heart rate above 110 bpm (LR 26.7), and rales at pulmonary auscultation (LR 23.3) were all associated with a diagnosis of heart failure, but were infrequent findings in patients with heart failure (sensitivity <10%). Symptoms and signs, and clinical history had limited value in diagnosing heart failure when used alone. The signs and symptoms that best predicted a diagnosis of heart failure were those associated with more severe disease. If investigation is limited to patients with more definite symptoms and signs of heart failure, fewer than 50% of cases will be identified and a large number of patients with mild symptoms will be missed.Keywords
This publication has 27 references indexed in Scilit:
- Guidelines for the diagnosis and treatment of chronic heart failureEuropean Heart Journal, 2001
- Congestive heart failure despite normal left ventricular systolic function in a population-based sample: the Strong Heart StudyThe American Journal of Cardiology, 2000
- Assessing diagnosis in heart failure: which features are any use?QJM: An International Journal of Medicine, 1997
- Patients with fatigue in general practice: a prospective study.BMJ, 1993
- DIAGNOSTIC VALUE OF THE APEX BEATThe Lancet, 1989
- Recommendations concerning use of echocardiography in hypertension and general population research.Hypertension, 1987
- An analysis of physicians' reasons for prescribing long-term digitalis therapy in outpatientsJournal of Chronic Diseases, 1985
- Echocardiographic measurements in normal subjects from infancy to old age.Circulation, 1980
- Report of the American Society of Echocardiography Committee on Nomenclature and Standards in Two-dimensional Echocardiography.Circulation, 1980
- Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements.Circulation, 1978