title: The diagnosis of heart failure in European primary care: The IMPROVEMENT Programme survey of perception and practice.
abstract: OBJECTIVE
  To examine European primary care physicians (PCPs) views on diagnosis of heart failure and compare perceptions with actual practice.
  
  
  METHODS
  Semi-structured PCP interviews and case note review on a random sample of heart failure patients.
  
  
  METHODS
  1363 primary care physicians from 14 countries and 11,062 patient notes.
  
  
  METHODS
  Perceptions of PCPs compared to actual performance in heart failure (HF) diagnosis.
  
  
  RESULTS
  Over 50% of patients with HF were above 70 years of age. Most subjects presented with typical clinical symptoms and objective signs of HF. In 50% of cases, HF was mainly diagnosed by PCPs. New York Heart Association classification was used by 50% of physicians. Electrocardiogram and chest X-ray were the most used diagnostic tests (90% and 84% respectively). PCPs considered echocardiography as having low diagnostic value, with only 48% routine usage. However, in actual practice echocardiography was used in 82% of diagnoses. Systolic dysfunction was observed in 51% HF subjects, but only 50% of physicians would differentiate systolic from diastolic heart failure.
  
  
  CONCLUSIONS
  There was low use of NYHA classification (which denotes symptom severity) and differentiation between systolic and diastolic causes (which determines treatment strategies).
authors.affiliation: Primary Care Clinical Sciences Building, University of Birmingham, Birmingham B15 2TT, United Kingdom. f.d.r.hobbs@bham.ac.uk
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
authors.forename: Jerzy
authors.initials: J
authors.lastname: Korewicki
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: Joanne
authors.initials: J
authors.lastname: Eastaugh
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D004562:Electrocardiography; D005060:Europe; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care; D014463:Ultrasonography