title: A management programme for suspected heart failure in primary care in cooperation with specialists in cardiology.
abstract: BACKGROUND
  The diagnosis of new onset congestive heart failure (CHF) is often difficult as symptoms and signs are non-specific. Proper diagnostic investigations and treatments are underused in primary care.
  
  
  OBJECTIVE
  To describe a management programme for patients with suspected CHF in primary care in cooperation with specialists in cardiology.
  
  
  METHODS
  Prospective study of 102 consecutive primary care patients with suspected new onset CHF referred to an easily accessible hospital-based cardiology outpatient clinic management programme. Following clinical examination, ECG, echocardiography, blood chemistry including NT-proBNP, and assessment of NYHA class and quality of life (EQ5D), patients with a confirmed diagnosis of CHF were prescribed medication with advice on titration and target doses. Trained CHF nurses gave Information on CHF and provided follow up.
  
  
  RESULTS
  Half (47%) of the referred patients had the diagnosis of CHF confirmed. Low NT-proBNP values (< 300 ng/l) provided a negative predictive value of 73%. Respiratory tract diseases were common differential diagnoses. At one year of follow-up, medication in the CHF group was 86% ACE-inhibitors/angiotensin receptor blockers, 61% ß-blocking agents, and 81% diuretics (P < 0.001 for the increase in ACE-inhibitors/angiotensin receptor blockers from baseline). NYHA class improved from baseline (median 2, range: 1-3) to one year (P < 0.05), whereas NT-proBNP (1491-1261 ng/l), and quality of life (EQ5D; 67-67) were unchanged.
  
  
  CONCLUSIONS
  A management programme to optimize quality of care for patients with suspected new onset CHF in primary care, with referral to a hospital-based specialist team, can be applied successfully.
authors.affiliation: Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine , Stockholm , Sweden.
authors.forename: Märit
authors.initials: M
authors.lastname: Mejhert
authors.forename: Thomas
authors.initials: T
authors.lastname: Kahan
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002309:Cardiology / Q000379:methods*; D015331:Cohort Studies; D003299:Cooperative Behavior; D019468:Disease Management; D004232:Diuretics / Q000627:therapeutic use*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration; D010446:Peptide Fragments / Q000097:blood; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Heart failure; management programme; natriuretic peptides; primary health care