[Ambiguities in the diagnosis of heart failure]

The diagnosis of heart failure has improved in the renewed heart failure practice guideline of the Dutch College of General Practitioners (NHG), of which the contents correspond to the multidisciplinary guideline 'Heart failure 2010'. This guideline recommend cut-off values for NT-proBNP for exclusion of heart failure and an echocardiogram for confirming diagnosis. In our opinion, however, the guideline will refer too many patients to hospital - partly due to the low cut-off values for NT-proBNP for excluding chronic heart failure - risking unnecessary diagnostic measures. The selection of patients requiring referral may be improved by refining both the risk estimation of heart failure and the use of cut-off values. The purpose of an echocardiogram is also still a matter for debate. We propose that patients be selected for echocardiography both for the diagnosis of heart failure and to investigate the underlying cause, implying referral to a cardiologist prior to echocardiography. Echocardiography for the diagnosis of heart failure alone may delay the institution of appropriate therapies.