title: Signs for early diagnosis of heart failure in primary health care.
abstract: OBJECTIVE
  The current guidelines for the diagnosis of heart failure (HF) are based on studies of hospital-based patients. The aim of this study is to describe the symptoms, clinical signs, and diagnostic procedures confirming the diagnosis of HF in primary health care.
  
  
  METHODS
  Data were prospectively collected during a 2-year period by a nationwide network of sentinel practices. All adult patients without known HF, for which the diagnosis of HF was clinically suspected for the first time, were registered. When diagnosed, HF was confirmed after 1 month.
  
  
  RESULTS
  754 patients with a suspicion of HF were recorded. The diagnosis of HF was confirmed for 74% of the patients. The average age of the patients with confirmed HF was 77.7 years, and for those without HF 75.6 years (P = 0.018). From a logistic regression, breathlessness on exercise (P < 0.001), limitations of physical activity (P = 0.003), and orthopnea (P = 0.040) were the symptoms most associated with HF. The clinical signs most associated with HF, were pulmonary rales (P < 0.001), peripheral edema (P < 0.001), and raised jugular venous pressure (P = 0.039). An electrocardiogram was performed in 75% of the cases, blood analyses in 68%, echocardiogram in 63%, chest X-ray in 61%, and determination of natriuretic peptides in 11% of the cases.
  
  
  CONCLUSIONS
  Many clinical signs may occur in patients with HF. However, the occurrence of peripheral edema, breathlessness on exercise, or pulmonary rales, are highly suggestive for HF when diagnosed in primary health care, as is the case in hospital-admitted patients. The diagnosis of HF was often left unconfirmed by an echocardiogram and/or an electrocardiogram.
authors.affiliation: Scientific Institute of Public Health, Unit of Epidemiology, Brussels, Belgium. dirk.devroey@vub.ac.be
authors.forename: Dirk
authors.initials: D
authors.lastname: Devroey
authors.forename: Viviane
authors.initials: V
authors.lastname: Van Casteren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D016009:Chi-Square Distribution; D042241:Early Diagnosis; D004487:Edema / Q000209:etiology; D005080:Exercise Test; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis*; D006334:Heart Function Tests; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011446:Prospective Studies; D012120:Respiration Disorders / Q000209:etiology; D012135:Respiratory Sounds / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors