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European Journal of Heart Failure 2009 11(1):92-98; doi:10.1093/eurjhf/hfn006
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Adequacy of diagnosis and treatment of chronic heart failure in primary health care in Sweden

Ulf Dahlstrom1,*, Jan Hakansson2, Karl Swedberg3 and Anders Waldenstrom4

1 University Hospital, Cardiology Linköping, Sweden
2 Dep Primary Care Center, Krokom, Sweden
3 Department of emergency and cardiovascular medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
4 University Hospital, Heart Center, Umeå, Sweden

* Corresponding author. Email: ulf.dahlstrom{at}lio.se


  Abstract

Aims: We performed an observational multicentre study to obtain information of the diagnostic tools and treatments currently used in patients with chronic heart failure (CHF) in primary health care (PHC) in Sweden. Data were collected from 2093 patients in 158 randomly selected PHC centres.

Methods and results: The mean age was 79 years. The dominating aetiology of HF was hypertension and/or ischaemic heart disease. Diagnosis was based on symptoms and/or ECG and/or chest X-ray in 69% of the patients. Treatment with a renin–angiotensin system (RAS) blocker was ongoing in 74% of the patients, but only 37% had ≥50% of the recommended target dose. In 68%, treatment with a beta-blocker (BB) was present, but only 31% had ≥50% of the recommended target dose. Only 42% of the patients were on treatment with an RAS blocker and a BB and only 20% had ≥50% of the recommended target dose.

Conclusion: The diagnostic criteria for CHF according to the European Society of Cardiology were fulfilled in only ~30% of the patients. In addition, evidenced-based treatments to reduce morbidity and mortality were markedly underused, particularly regarding dosing. Our findings may reflect the patients’ high age and the presence of important co-morbidities.

Key Words: Heart failure • Primary health care • Diagnosis • Treatment

Received February 25, 2008; Revised September 1, 2008; Accepted September 8, 2008


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