Management of heart failure in primary health care. A retrospective study on electronic patient records in a registered population.
OBJECTIVE
To study the prevalence, patient characteristics and management of patients with heart failure, and the feasibility of using everyday electronic patient records for research.


METHODS
A 4-year retrospective database study.


METHODS
Primary health care in Stockholm.


METHODS
Forty-six general practitioners, with a registered population of 100,222 inhabitants.


METHODS
Number of patients with heart failure, frequencies of their comorbidity, investigations and treatments.


RESULTS
Out of the registered population, 667 (0.7%) patients had the diagnosis heart failure and fulfilled the diagnostic criteria in our study, and 98.7% had a comorbidity. The most frequent were ischaemic heart disease (37.2%), hypertension (27.3%), chronic atrial fibrillation (23.7%) and diabetes (22.3%). Major investigations were chest radiograph (66.3%) and echocardiograph (16.9%). Frequent pharmacological treatments were diuretics (90.9%), cardiac glycosides (48.1%), platelet aggregation inhibitors (32.7%), vasodilators (31.6%), angiotensin-converting enzyme inhibitors (27.4%) and beta blockers (14.5%). Diuretics were more frequent for females (p = 0.016) and angiotensin-converting enzyme inhibitors for males (p < 0.001).


CONCLUSIONS
Heart failure was common among the elderly and constituted a complex clinical problem. It seemed that these patients could have been managed more adequately. There were gender differences concerning comorbidity and management. Electronic patient records were feasible for research, although several areas needed improvement.
Nilsson
Gunnar
G
Department of Clinical Science, Karolinska Institutet, Stockholm, Sweden. gunnar.nilsson@nlpo.sll.se
Strender
Lars-Erik
LE
D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000145:classification / Q000627:therapeutic use; D004363:Drug Utilization; D005194:Family Practice / Q000379:methods* / Q000592:standards; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008485:Medical Audit; D016347:Medical Records Systems, Computerized; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology
D002317:Cardiovascular Agents