© 2000 European Society of Cardiology
A Rapid Access Heart Failure Clinic provides a prompt diagnosis and appropriate management of new heart failure presenting in the community
a Cardiac Medicine, Imperial College School of Medicine, National Heart and Lung Institute Dovehouse Street, London SW3 6LY, UK
b Cardiology Research Group, Department of Medicine and Therapeutics, University of Aberdeen Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
* Corresponding author. Tel.: +44-20-7351-8855; fax: +44-20-7351-8856. E-mail address: k.fox{at}ic.ac.uk (K.F. Fox).
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Abstract |
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Background and aims: The diagnosis of heart failure is an important clinical problem and yet reported diagnostic accuracy in primary care is less than 50%. We established a Rapid Access Heart Failure Clinic (RAHFC) in a district general hospital serving a population of 292000 in SE London, UK, to diagnose and manage new cases of heart failure presenting for the first time in the community.
Methods: Patients with suspected new onset heart failure were referred by their Primary Care Physician without appointment for clinical assessment on the same or next working day. Assessment by a specialist registrar in cardiology included history, examination, chest X-ray, electrocardiogram (ECG) and echocardiogram. When a diagnosis of heart failure was made appropriate treatment, including angiotensin converting enzyme inhibitors (ACEI), was started.
Results: Over 15 months 383 patients were seen (0.4 cases/100000 population/weekday) 178/383 (46%) were considered to have definite or possible heart failure at the initial assessment in the RAHFC. A normal ECG (negative predictive value 94%) and chest X-ray virtually excluded the diagnosis of heart failure. After subsequent specialist investigations and follow-up, including a trial of therapy where appropriate, 101/383 (26%) were finally diagnosed as clinical heart failure. ACEI therapy was commenced in 56/57 (98%) of patients in whom it was considered appropriate.
Conclusion: The RAHFC provided rapid assessment, prompt diagnosis and early introduction of life prolonging therapy for patients presenting with suspected heart failure in the community.
Key Words: Heart failure • Diagnosis • Treatment
Received March 9, 2000; Revised May 17, 2000; Accepted June 20, 2000
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