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Routes to diagnosis of heart failure: observational study using linked data in England

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Title: Routes to diagnosis of heart failure: observational study using linked data in England
Authors: Bottle, A
Kim, D
Aylin, P
Cowie, MR
Majeed, A
Hayhoe, B
Item Type: Journal Article
Abstract: OBJECTIVE: Timely diagnosis and management of heart failure (HF) is critical, but identification of patients with suspected HF can be challenging, especially in primary care. We describe the journey of people with HF in primary care from presentation through to diagnosis and initial management. METHODS: We used the Clinical Practice Research Datalink (primary care consultations linked to hospital admissions data and national death registrations for patients registered with participating primary care practices in England) to describe investigation and referral pathways followed by patients from first presentation with relevant symptoms to HF diagnosis, particularly alignment with recommendations of the National Institute for Health and Care Excellence guideline for HF diagnosis. RESULTS: 36 748 patients had a diagnosis of HF recorded that met the inclusion criteria between 1 January 2010 and 31 March 2013. For 29 113 (79.2%) patients, this was first recorded in hospital. In the 5 years prior to diagnosis, 15 057 patients (41.0%) had a primary care consultation with one of three key HF symptoms recorded, 17 724 (48.2%) attended for another reason and 3967 (10.8%) did not see their general practitioner. Only 24% of those with recorded HF symptoms followed a pathway aligned with guidelines (echocardiogram and/or serum natriuretic peptide test and specialist referral), while 44% had no echocardiogram, natriuretic peptide test or referral. CONCLUSIONS: Patients follow various pathways to the diagnosis of HF. However, few appear to follow a pathway supported by guidelines for investigation and referral. There are likely to be missed opportunities for earlier HF diagnosis in primary care.
Issue Date: 5-Oct-2017
Date of Acceptance: 12-Sep-2017
URI: http://hdl.handle.net/10044/1/51806
DOI: https://dx.doi.org/10.1136/heartjnl-2017-312183
ISSN: 1355-6037
Publisher: BMJ Publishing Group
Start Page: 600
End Page: 605
Journal / Book Title: Heart
Volume: 104
Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Sponsor/Funder: Imperial College Healthcare NHS Trust
National Institute for Health Research (NIHR)
Dr Foster Intelligence
Funder's Grant Number: RDPSC 79560
RDPSC 79560
N/A
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
heart failure
electronic medical records
health care delivery
quality and outcomes of care
PRIMARY-CARE
ELDERLY-PATIENTS
MANAGEMENT
GUIDELINES
PREVALENCE
QUALITY
1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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