A Rapid Access Heart Failure Clinic provides a prompt diagnosis and appropriate management of new heart failure presenting in the community.
OBJECTIVE
The diagnosis of heart failure is an important clinical problem and yet reported diagnostic accuracy in primary care is less than 50%. We established a Rapid Access Heart Failure Clinic (RAHFC) in a district general hospital serving a population of 292,000 in SE London, UK, to diagnose and manage new cases of heart failure presenting for the first time in the community.


METHODS
Patients with suspected new onset heart failure were referred by their Primary Care Physician without appointment for clinical assessment on the same or next working day. Assessment by a specialist registrar in cardiology included history, examination, chest X-ray, electrocardiogram (ECG) and echocardiogram. When a diagnosis of heart failure was made appropriate treatment, including angiotensin converting enzyme inhibitors (ACEI), was started.


RESULTS
Over 15 months 383 patients were seen (0.4 cases/100,000 population/weekday) 178/383 (46%) were considered to have definite or possible heart failure at the initial assessment in the RAHFC. A normal ECG (negative predictive value 94%) and chest X-ray virtually excluded the diagnosis of heart failure. After subsequent specialist investigations and follow-up, including a trial of therapy where appropriate, 101/383 (26%) were finally diagnosed as clinical heart failure. ACEI therapy was commenced in 56/57 (98%) of patients in whom it was considered appropriate.


CONCLUSIONS
The RAHFC provided rapid assessment, prompt diagnosis and early introduction of life prolonging therapy for patients presenting with suspected heart failure in the community.
Fox
K F
KF
Cardiac Medicine, Imperial College School of Medicine, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, UK. k.fox@ic.ac.uk
Cowie
M R
MR
Wood
D A
DA
Coats
A J
AJ
Poole-Wilson
P A
PA
Sutton
G C
GC
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006767:Hospitals, District / Q000706:statistics & numerical data; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013997:Time Factors
D000806:Angiotensin-Converting Enzyme Inhibitors