The diagnosis of heart failure in European primary care: The IMPROVEMENT Programme survey of perception and practice

Objective: To examine European primary care physicians (PCPs) views on diagnosis of heart failure and compare perceptions with actual practice. Design: Semi-structured PCP interviews and case note review on a random sample of heart failure patients. Participants: 1363 primary care physicians from 14 countries and 11,062 patient notes. Main outcome measures: Perceptions of PCPs compared to actual performance in heart failure (HF) diagnosis. Results: Over 50% of patients with HF were above 70 years of age. Most subjects presented with typical clinical symptoms and objective signs of HF. In 50% of cases, HF was mainly diagnosed by PCPs. New York Heart Association classification was used by 50% of physicians. Electrocardiogram and chest X-ray were the most used diagnostic tests (90% and 84% respectively). PCPs considered echocardiography as having low diagnostic value, with only 48% routine usage. However, in actual practice echocardiography was used in 82% of diagnoses. Systolic dysfunction was observed in 51% HF subjects, but only 50% of physicians would differentiate systolic from diastolic heart failure. Conclusions: There was low use of NYHA classification (which denotes symptom severity) and differentiation between systolic and diastolic causes (which determines treatment strategies).