Diagnosis of heart failure in primary care

Heart failure is a syndrome resulting from a structural or functional cardiac disorder. For a diagnosis of heart failure to be made, there should be symptoms or signs, such as breathlessness, effort intolerance or fluid retention, together with objective evidence of cardiac dysfunction. Heart failure is an increasingly important chronic disease syndrome, associated with poor prognosis, poor quality of life for patients, and high healthcare costs.1 w1 In the general population, where all grades of heart failure are represented, 5 year mortality is around 42%2; however, where the diagnosis is established during a hospital admission, 5 year mortality is between 50–75%,3 w2 although the prognosis has improved in the past 10 years. Studies including objective assessment of left ventricular (LV) function, usually echocardiography, indicate a prevalence of left ventricular systolic dysfunction (LVSD) of 2.9% in patients under 754 and up to 7.5% in 75–84 year olds.w3 In the largest recent prospective evaluation of heart failure in the community, definite heart failure was found in 2.3% (95% confidence interval (CI) 1.9% to 2.8%) of the population, with left ventricular ejection fraction (LVEF) <40% in 41% of cases. However, if the LVEF cut-off was set at under 50% rather than 40%, now advocated in some guidelines, 3.1% (95% CI 2.6% to 3.7%) of people aged 45 or over were defined as having heart failure.5 Estimates on heart failure incidence are less available, and vary from 0.9–2.26 per 1000 females (age 45–74) per year and 1.6–4.6 men per 1000 population (age 45–74) per year. Incidence rises rapidly in the elderly, with 1% of men per year developing heart failure after 75 and almost 2% per year in the over 85s. The typical primary care physician, caring for 2000 patients, is likely to have 40–50 patients with heart failure (more …