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- Title
A Rapid Access Heart Failure Clinic provides a prompt diagnosis and appropriate management of new heart failure presenting in the community.
- Authors
Fox, Kevin F.; Cowie, Martin R.; Wood, David A.; Coats, Andrew J.S.; Poole-Wilson, Philip A.; Sutton, George C.; Fox, K F; Cowie, M R; Wood, D A; Coats, A J; Poole-Wilson, P A; Sutton, G C
- Abstract
<bold>Background and Aims: </bold>The diagnosis of heart failure is an important clinical problem and yet reported diagnostic accuracy in primary care is less than 50%. We established a Rapid Access Heart Failure Clinic (RAHFC) in a district general hospital serving a population of 292,000 in SE London, UK, to diagnose and manage new cases of heart failure presenting for the first time in the community.<bold>Methods: </bold>Patients with suspected new onset heart failure were referred by their Primary Care Physician without appointment for clinical assessment on the same or next working day. Assessment by a specialist registrar in cardiology included history, examination, chest X-ray, electrocardiogram (ECG) and echocardiogram. When a diagnosis of heart failure was made appropriate treatment, including angiotensin converting enzyme inhibitors (ACEI), was started.<bold>Results: </bold>Over 15 months 383 patients were seen (0.4 cases/100,000 population/weekday) 178/383 (46%) were considered to have definite or possible heart failure at the initial assessment in the RAHFC. A normal ECG (negative predictive value 94%) and chest X-ray virtually excluded the diagnosis of heart failure. After subsequent specialist investigations and follow-up, including a trial of therapy where appropriate, 101/383 (26%) were finally diagnosed as clinical heart failure. ACEI therapy was commenced in 56/57 (98%) of patients in whom it was considered appropriate.<bold>Conclusion: </bold>The RAHFC provided rapid assessment, prompt diagnosis and early introduction of life prolonging therapy for patients presenting with suspected heart failure in the community.
- Subjects
UNITED Kingdom; ENGLAND; HEART failure; HEART failure clinics; DIAGNOSIS methods; PRIMARY care; HOSPITALS; HOSPITAL care; DIAGNOSIS; ACE inhibitors; HEART failure treatment; COMPARATIVE studies; OUTPATIENT services in hospitals; RESEARCH methodology; MEDICAL cooperation; MEDICAL referrals; PUBLIC hospitals; RESEARCH; TIME; EVALUATION research
- Publication
European Journal of Heart Failure, 2000, Vol 2, Issue 4, p423
- ISSN
1388-9842
- Publication type
journal article
- DOI
10.1016/S1388-9842(00)00108-2