Patient differences related to management in general practice and the hospital: a cross-sectional study of heart failure in the community.

Abstract:

AIM:To compare patients treated for heart failure in relation to the management in general practices versus hospital admission. METHODS AND RESULTS:Twelve randomly selected general practices (GP) were screened for patients receiving ACE-inhibitor, digoxin, or loop diuretic treatment. The first 500 volunteers of 959 potential subjects were invited to a cardiac examination after exclusion of 235 frail, physically or mentally disabled patients. A diagnosis of heart failure during hospital admission (Hospital-HF, n = 102) was more related (p < 0.05) to male sex (45% vs. 21%), advanced age (73 vs. 70 years), breathlessness (75% vs. 62%), LV systolic dysfunction (47% vs. 20%), objective cardiac abnormality (92% vs. 65%) and higher 4-year mortality (33% vs. 15%) than patients taking loop diuretics due to signs and symptoms of heart failure in GP (GP-HF). Patients without clinical heart failure (n = 301) had the same survival but less symptoms and cardiac abnormalities than GP-HF patients. CONCLUSION:A surplus morbidity and mortality was related to a hospital-based rather than a GP based diagnosis of HF. Patients managed in GP were different from patients entering previous clinical trials of heart failure. We estimate that the pool of patients hospitalised with systolic heart failure would be increased from 1.3 to 1.4 more if all patients from primary care were included.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Nielsen OW,McDonagh T,Cowburn P,Blue L,Robb SD,Dargie H

doi

10.1016/j.ehj.2004.06.033

subject

Has Abstract

pub_date

2004-10-01 00:00:00

pages

1718-25

issue

19

eissn

0195-668X

issn

1522-9645

pii

S0195-668X(04)00430-0

journal_volume

25

pub_type

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