Earlier heart failure diagnosis in primary care

Clare J Taylor

doi:10.3399/bjgp23X731481

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Earlier heart failure diagnosis in primary care
Clare J. Taylor

Published on: 10 January 2023
An earlier diagnosis of heart failure
John Sharvill

Published on: 02 January 2023

Published on: (10 January 2023)
Page navigation anchor for Earlier heart failure diagnosis in primary care
Earlier heart failure diagnosis in primary care
Clare J. Taylor, Academic GP, University of Oxford
Thank you to Dr Shavill for reading my editorial ‘Earlier heart failure diagnosis in primary care’. As a practising GP, I appreciate how difficult heart failure diagnosis can be, particularly in the presence of multimorbidity, and I was very mindful of the intense pressures general practice when writing the piece.

Reference 2 is widely cited given the novel findings and our more recent work confirms patients are still frequently admitted to hospital at the time of heart failure diagnosis and have worse outcomes. Reference 7 is our survival analysis of over 55,000 people with heart failure published in the BMJ. Almost half of patients had heart failure as a contributory factor on their death certificate, and the Kaplan Meier curve in Figure 5 of the paper shows the significant differences in mortality: people with heart failure were three times more likely to die than comparators of the same age and sex (hazard ratio 3.36 (95%CI 3.31 to 3.42)).

The National Institute for Health and Care Excellence (NICE) chronic heart failure guideline recommends natriuretic peptide testing for patients presenting with symptoms suggestive of heart failure to guide referral decisions,¹ but I agree there can then be a significant wait for echocardiography and the reports are often complex. NICE recommend that a diagnosis of heart failure is made by a specialist. I agree accessible training in a variety of formats for the busy GP could help to raise aware...
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Thank you to Dr Shavill for reading my editorial ‘Earlier heart failure diagnosis in primary care’. As a practising GP, I appreciate how difficult heart failure diagnosis can be, particularly in the presence of multimorbidity, and I was very mindful of the intense pressures general practice when writing the piece.

Reference 2 is widely cited given the novel findings and our more recent work confirms patients are still frequently admitted to hospital at the time of heart failure diagnosis and have worse outcomes. Reference 7 is our survival analysis of over 55,000 people with heart failure published in the BMJ. Almost half of patients had heart failure as a contributory factor on their death certificate, and the Kaplan Meier curve in Figure 5 of the paper shows the significant differences in mortality: people with heart failure were three times more likely to die than comparators of the same age and sex (hazard ratio 3.36 (95%CI 3.31 to 3.42)).

The National Institute for Health and Care Excellence (NICE) chronic heart failure guideline recommends natriuretic peptide testing for patients presenting with symptoms suggestive of heart failure to guide referral decisions,¹ but I agree there can then be a significant wait for echocardiography and the reports are often complex. NICE recommend that a diagnosis of heart failure is made by a specialist. I agree accessible training in a variety of formats for the busy GP could help to raise awareness of the opportunities for earlier heart failure diagnosis.

Reference

1. National Institute for Health and Care Excellence (2018) Chronic heart failure in adults: diagnosis and management NG106 (NICE, London) www.nice/org.uk/guidance/ng106 (accessed 5 Dec 2022).
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Competing Interests: Author of the editorial. Personal fees from Roche outside the submitted work.
Published on: (2 January 2023)
Page navigation anchor for An earlier diagnosis of heart failure
An earlier diagnosis of heart failure
John Sharvill, Part time GP, NHS
Thank you for this important article but I fear it may add fuel to GP bashing. The Date set (ref 2) is dated 2010 to 2013 and I would hope (without direct evidence but from previously working as a GPwSI in cardiology) things have changed radically in the last 9 years. The reference (ref 7) for no improvement in mortality plays down that only 7.2 % of those dying had heart failure as the cause of death and there was an improvement over the time albeit not large-but no comparison in the reference to controls of the same age. My main reason though for writing is we are de-skilling the normal GP in managing a common illness. If the guidelines empowered a GP to manage this with easy access to an echo (not forgetting initial clinical examination, ECG, and symptom treatment with diuretics) and the echo report having useful advice rather than numerical values. Perhaps regular updated training to take priority over safeguarding ''updates' would save many more lives and improve job satisfaction.

Competing Interests: None declared.