The diagnosis of heart failure in European primary care: The IMPROVEMENT Programme survey of perception and practice

Objective: To examine European primary care physicians (PCPs) views on diagnosis of heart failure and compare perceptions with actual practice. Design: Semi-structured PCP interviews and case note review on a random sample of heart failure patients. Participants: 1363 primary care physicians from 14 countries and 11,062 patient notes. Main outcome measures: 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 FIR 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). (c) 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.