Management of chronic heart failure in the community: role of a hospital based open access heart failure service
| Autor: | D Cartwright, P Nightingale, S Shah, M K Davies |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Male
Cardiac output medicine.medical_specialty Heart disease Cost effectiveness Cardiac Output Low Cardiovascular Medicine Lower risk Health Services Accessibility Cohort Studies Ventricular Dysfunction Left Risk Factors Internal medicine Humans Medicine Hospitals Teaching Referral and Consultation Aged Ejection fraction medicine.diagnostic_test business.industry medicine.disease Dyspnea England Echocardiography Heart failure Chronic Disease Cardiology Female Cardiology Service Hospital Cardiology and Cardiovascular Medicine business Chest radiograph Program Evaluation Cohort study |
| Zdroj: | Heart. 90:755-759 |
| ISSN: | 0007-0769 |
| DOI: | 10.1136/hrt.2002.006460 |
| Popis: | To evaluate the role of an open access heart failure service based at a teaching hospital for the diagnosis and treatment optimisation of patients with heart failure in the community and to identify measures that may further enhance the effectiveness of such a service.963 patients with suspected heart failure seen over an eight year period referred by their general practitioners to the cardiology department at a district general hospital.Presence or absence of left ventricular systolic dysfunction (LVSD) (left ventricular ejection fraction50% on echocardiography), and determination of the risk factors and predictors of LVSD.The majority of the patients were women (60% v 40%) and elderly (mean age 68.8 years). On echocardiography, only 30.8% were found to have LVSD. Patients were more likely to have LVSD if they were men (42.3% v 23.1%, p0.001, relative risk (RR) 1.8), were60 years of age (33.5% v 20.8%, p0.001, RR 1.6), or had a history of diabetes (49.4% v 29.1%, p0.001, RR 1.7), ischaemic heart disease (36.5% v 29.1%, p = 0.04, RR 1.3), or atrial fibrillation (52.6% v 27.8%, p0.001, RR 1.9). An abnormal ECG (48.4% v 19.5%, p0.001, RR 2.5) and cardiothoracic ratio0.5 on chest radiograph (44.3% v 17.8%, p0.001, RR 2.5) were found to be good predictors of LVSD. A normal ECG (negative predictive value 80.5%) and a cardiothoracic ratio of0.5 (negative predictive value 82.2%) can be used as baseline measures to identify patients with lower risk of developing LVSD (combined negative predictive value 87.9%).An open access heart failure clinic is effective for the diagnosis and management of chronic heart failure in community based patients. The presence of risk factors and simple baseline tests can be used to identify patients with LVSD in the community. The introduction of a protocol based on these findings into a referral system can improve the efficiency and cost effectiveness of such a service. |
| Databáze: | OpenAIRE |
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