Umsetzung von diagnostischen Empfehlungen bei Herzinsuffizienz
| Autor: | Eva Hummers-Pradier, Martin Scherer, K Stich, Katrin Korb, Jean-François Chenot |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Tachycardia
medicine.medical_specialty 020205 medical informatics medicine.medical_treatment 02 engineering and technology 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Edema 0202 electrical engineering electronic engineering information engineering medicine 030212 general & internal medicine Intensive care medicine Cardiac catheterization business.industry Medical record General Medicine Guideline medicine.disease 3. Good health Heart failure General practice Emergency medicine medicine.symptom business Paroxysmal dyspnea |
| Zdroj: | DMW - Deutsche Medizinische Wochenschrift. 135:120-124 |
| ISSN: | 1439-4413 0012-0472 |
| DOI: | 10.1055/s-0029-1244827 |
| Popis: | BACKGROUND National and international guidelines for the management of congestive heart failure (HF) suggest a variety of procedures for establishing its diagnosis and monitoring its course. The aim of this cross-sectional study was to investigate which of these recommendations were actually implemented and documented in the setting of general medical practice. METHODS Patients receiving at least one cardiovascular drug (World health [WHO] anatomical chemical classification [ATC] class C) were identified from electronic medical records from 5 general practices from 1.4.2001 to 1.10.2004. Those patients with the documented diagnosis of HF were selected. All patients' records were reviewed and those diagnostic procedures and clinical findings were recorded on a standardized data extraction form that had been used to establish the diagnosis of HF. RESULTS An electrocardiogram had been documented or retrieved in the chart in 41.2% of a total of 829 patients, an chest X-ray in 28.2%, an echocardiogram in 17.2%, and a cardiac catheterization performed in 1.8%. Serum natriuretic peptides were never recorded. Additionally the following symptoms and clinical signs were extracted from the paper chart: ankle edema (39.3%), exertional dyspnea (22.7%), rales (21.5%), cardiomegaly (19.0%), paroxysmal dyspnea (16.6%), pleural effusions (9.2%), tachycardia (6.7%) and acute pulmonary edema, hepatomegaly, nocturnal cough or jugular venous distension in fewer than 5%. CONCLUSION Only a few of those clinical signs and diagnostic procedures recommended by guidelines for diagnosing HF were recorded in general practice. The reasons for this finding remain unclear. Even under the assumption that not all observed clinical signs and diagnostic procedures were documented, these findings reflect the actual diagnostic strategy in daily practice. The observed discrepancy between guideline recommendation and reality in everyday practice deserve attention. On the one hand, there is a need for improving the diagnostic approach to HF; on the other, guidelines need to set priorities of the recommendations for diagnosing HF. |
| Databáze: | OpenAIRE |
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