Cent Eur J Public Health 2006, 14(2):86-89 | DOI: 10.21101/cejph.a3368
Practices of Clinical Examination of Heart Failure Patients in Primary Health Care
- 1 Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland
- 2 Unit of General Practice, Oulu University Hospital, Oulu, Finland
- 3 Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
The aim of this cross-sectional cohort study was to examine practices of clinical examination of heart failure patients in three primary health care regions in northern Finland. Altogether, 825 randomly selected heart failure patients aged 45 years or older, who had special reimbursement for drugs for the treatment of heart failure, were included. Main outcome measures were the frequency of medical visits and the mode of clinical examinations during control visits and symptomatic visits due to heart failure made by general practitioners.
The prevalence of heart failure was 2% among those aged 45-75 years and 18% among the older ones. No differences existed in the incidence of all medical visits made as a result of heart failure, between the regions. ECG recordings, auscultation of the heart and lungs, measurements of blood pressure and recordings of ankle swelling were carried out in 72%, 79%, 85%, 90% and 59% of cases of control visits, and in 78%, 63%, 79%, 77% and 49% of cases in symptomatic visits, respectively. Chest X-ray examinations and recording of liver size were seldom carried out: 16% and 12% in control visits, and 19% and 11% in symptomatic visits, respectively. Important prognostic markers of heart failure were recorded even more rarely: jugular venous pressure, in 1% of control visits and 3% of symptomatic visits and the third heart sound not at all. NYHA grading had been carried out in 8% and echocardiography in 13% of cases.
The prevalence of heart failure was higher than in many clinical studies, suggesting high number of false positive heart failure diagnoses made in primary health care. Some clinical examinations of significant prognostic value in heart failure are underused by general practitioners. Therefore, further education among general practitioners is needed to improve the practices of clinical examination in heart failure patients.
Keywords: heart failure, clinical examination, primary health care
Received: October 21, 2005; Revised: January 30, 2006; Accepted: January 30, 2006; Published: June 1, 2006 Show citation
References
- Tresch DD. Clinical manifestations, diagnostic assessment, and etiology of heart failure in elderly patients. Clin Geriatr Med. 2000 Aug;16(3):445-56.
Go to original source...
Go to PubMed...
- Khunti K, Baker R, Grimshaw G. Diagnosis of patients with chronic heart failure in primary care: usefulness of history, examination, and investigations. Br J Gen Pract. 2000 Jan;50(450):50-4.
- ClelandJG,ClarkA.Hasthesurvivaloftheheartfailurepopulationchanged? Lessons from trials. Am J Cardiol. 1999 Mar 11;83(5B):112D-19D.
Go to original source...
Go to PubMed...
- Cowie MR, Wood DA, Coats AJ, Thomson SG, Poole-Wilson PA. Incidence and aetiology of heart failure; a population-based study. Eur Heart J. 1999 Mar;20(6):421-8.
Go to original source...
Go to PubMed...
- Remes J, Reunanen A, Aromaa A, Pyörälä K. Incidence of heart failure in eastern Finland: a population-based surveillance study. Eur Heart J. 1992 May;13(5):588-93.
Go to original source...
Go to PubMed...
- Cleland JG, Cohen-Solal A, Aguilar JC, Dietz R, Eastaugh J, Follath F, et al. Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey. Lancet. 2002 Nov 23;360(9346):1631-9.
Go to original source...
- RemesJ,MiettinenH,ReunanenA,PyöräläK.Validityofclinicaldiagnosisof heart failure in primary health care. Eur Heart J. 1991 Mar;12(3):315-21.
Go to original source...
- McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971 Dec 23;285(26):1441-6.
Go to original source...
Go to PubMed...
- Remme WJ, Swedberg K; Task Force for the Diagnosis and Treatment of Chronic Heart Failure, European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J. 2001 Sep;22(17):1527-60.
Go to original source...
Go to PubMed...
- Butman SM, Ewy GA, Standen JR, Kern KB, Hahn E. Bedside cardiovascular examination in patients with severe chronic heart failure: importance of rest or inducible jugular venous distension. J Am Coll Cardiol. 1993 Oct;22(4):968-74.
Go to original source...
- Ishmail AA, Wing S, Ferguson J, Hutchinson TA, Magder S, Flegel KM. Interobserver agreement by auscultation in the presence of a third heart sound in patients with congestive heart failure. Chest. 1987 Jun;91(6):870-3.
Go to original source...
- Drazner MH, Rame JE, Stevenson LW, Dries DL. Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure. N Engl J Med. 2001 Aug 23;345(8):574-81.
Go to original source...
Go to PubMed...
- Joshi N. The third heart sound. South Med J. 1999 Aug;92(8):756-61.
Go to original source...
Go to PubMed...
- Adolph RJ. In defence of the stethoscope. Chest. 1998 Nov;114(5): 1235-7.
Go to original source...
Go to PubMed...
- Nilsson G, Strender LE. Management of heart failure in primary health care. Aretrospectivestudyonelectronicpatientrecordsinaregisteredpopulation. Scand J Prim Health Care. 2002 Sep;20(3):161-5.
Go to original source...
- WheeldonNM,MacDonaldTM,FluckerCJ,McKendrickAD,McDevittDG, Struthers AD. Echocardiography in chronic heart failure in the community. Q J Med. 1993 Jan;86(1):17-23.
- Kelly J, Kelleher K. The electrocardiogram in heart failure. Age Ageing. 2000 May;29(3):203-6.
Go to original source...
- BadgettRG,LuceyCR,MulrowCD.Cantheclinicalexaminationdiagnose left-sided heart failure in adults? JAMA. 1997 Jun 4;277(21):1712-9.
Go to original source...