Detection of heart failure at a primary care practice in a small town in central Poland

Background: Heart failure (HF) is commonly misdiagnosed, and the validity of diagnosis in primary care is poor. According to the guidelines, an electrocardiogram, a chest X-ray and a standard echocardiogram should be obtained and the level of B-type natriuretic peptide (BNP) should be determined in every patient with signs and symptoms suggestive of HF. Aim: We performed a community-based study to evaluate the diagnostic evaluation of patients with HF and/or HF risk factors carried out by primary care physicians. Methods: We screened the adult population of a small Polish town (5521 inhabitants). Inclusion criteria were as follows: age >= 55 years and either the diagnosis of HF or presence of at least one of the following HF risk factors: ischaemic heart disease and/or hypertension with complications and/or diabetes mellitus. Results: A total of 218 patients who met the inclusion criteria were invited to participate in the study and 175 of them (80.3%) were evaluated and followed up for 58 +/- 1 months. The diagnosis of HF was established in 38/175 patients (22%) (Group 1). The signs and symptoms of HF without the formal diagnosis of HF were present in 44/175 patients (25%) (Group 2) and 93/175 patients (53%) had neither HF nor its signs or symptoms (Group 3). During the follow-up, in some of patients from Groups 2 and 3, the diagnosis of HF was established and these patients crossed over to Group 1a. In 2009, there were 56 patients in Group 1a, 37 in Group 2a and 82 in Group 3a. At baseline, in years 2004/2005, echocardiograms were available in 37%, 25% and 17% of the patients in Groups 1, 2 and 3, respectively, chest radiograms in 86%, 54%, 58% of the patients, respectively, and BNP measurements in 5%, 5% and 0% of the patients, respectively. At the end of the follow-up we observed an increased number of diagnostic tests performed but the difference was not statistically significant. Conclusions: Our study showed a considerable discrepancy between the guidelines and primary practice and underscores the need to change the practical approach to diagnostic investigations, especially echocardiography and BNP measurements in HF patients.