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Chronic heart failure in Australian general practice. The Cardiac Awareness Survey and Evaluation (CASE) Study
1Alfred Hospital, Melbourne, VIC.
Insights
Chronic heart failure (CHF) is common in elderly patients presenting to general practitioners. A clinical algorithm can help detect new CHF cases, but angiotensin-converting enzyme (ACE) inhibitors are underused.
Area of Science:
- Gerontology
- Cardiology
- General Practice
Background:
- Chronic heart failure (CHF) is a prevalent condition in elderly populations.
- General practitioner (GP) awareness and diagnostic practices for CHF require investigation.
- Understanding the utilization of diagnostic tests and treatments is crucial for improving CHF management.
Purpose of the Study:
- To determine the frequency of chronic heart failure (CHF) in elderly patients presenting to general practitioners.
- To assess general practitioner (GP) awareness and diagnostic approaches for CHF.
- To evaluate a cardiac algorithm for suspected CHF and document cardiac investigations used.
Main Methods:
- A cross-sectional study involving 341 GPs across Australia assessed 22,060 patients aged 60 years and older.
- Patients were evaluated for previously diagnosed CHF or suspected CHF using a standardized algorithm.
- Data collected included aetiology, diagnostic assessments, investigations performed, and medications prescribed.
Main Results:
- Chronic heart failure (CHF) was diagnosed in 13.2% of patients (2905/22060), with 420 new diagnoses.
- Ischaemic heart disease and hypertension were the primary aetiological factors.
- Echocardiography use was suboptimal (22%) in newly suspected CHF cases, and angiotensin-converting enzyme (ACE) inhibitors were prescribed in 58.1% of CHF patients.
Conclusions:
- Chronic heart failure (CHF) is highly prevalent in the elderly population presenting to general practice.
- A simple clinical algorithm can identify approximately two new CHF cases per 100 elderly patients.
- Angiotensin-converting enzyme (ACE) inhibitors appear to be underutilized in the management of CHF.
Objectives:
To investigate the frequency and general practitioner awareness of patients with chronic heart failure (CHF), and to evaluate a cardiac algorithm and document cardiac investigations performed in establishing this diagnosis.
Design And Setting:
Between March and August 1998, consecutive patients aged 60 years and older presenting to their GP were assessed. In patients previously diagnosed with CHF, aetiology and diagnostic assessments were documented. In patients with suspected CHF (by a standardised algorithm, based on World Health Organization guidelines), further investigations and GP diagnosis were recorded.
Patients:
80 consecutive patients were assessed by each of 341 GPs throughout Australia, reflecting the Australian metropolitan/rural population mix of 1996. This provided a total of 22060 evaluable patients.
Main Outcome Measures:
Estimated numbers of patients with CHF in general practice (previously and newly diagnosed); major aetiological factors; use of ancillary diagnostic tests; drugs prescribed.
Results:
CHF was diagnosed in 2905 of 22060 patients (13.2%) (2485 previously diagnosed and 420 newly diagnosed). Major aetiological factors were ischaemic heart disease and hypertension. Echocardiography had been performed in 64% of previously diagnosed patients, but was performed in only 22% of possible CHF patients. Angiotensin-converting enzyme (ACE) inhibitors were prescribed in 58.1% of patients with CHF. Patients with evidence of left ventricular dysfunction were more likely to have received ACE inhibitors.
Conclusions:
CHF appears to be very common in the elderly, based on GP diagnosis of the condition. Of 100 patients aged 60 years and over presenting to their GP, two new cases of CHF will be detected using a simple clinical algorithm in conjunction with appropriate diagnostic tests. ACE inhibitors appear to be underutilised.