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Diagnosing heart failure: challenges in primary care
  1. Clare J Taylor
  1. Correspondence to Dr Clare J Taylor, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; clare.taylor{at}phc.ox.ac.uk

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Heart failure (HF) is a common, costly and treatable clinical syndrome.1 2 Over 920 000 people in England are living with the condition and 3%–4% of the National Health Service (NHS) budget is spent on HF services.3 Large clinical trials have established the clinical and cost-effectiveness of disease-modifying drugs and device therapies in improving quality of life, reducing hospitalisations and increasing survival for patients with HF with reduced ejection fraction.4 5 The same prognostic benefit was not seen in HF with preserved ejection fraction but diagnosis remains important to explain patients’ symptoms. In both types of HF, diuretics are effective in reducing fluid overload and exercise-based cardiac rehabilitation is beneficial once patients are stable.

Timely and accurate diagnosis is key to accessing appropriate, evidence-based treatment. People with HF initially experience symptoms of breathlessness, fatigue and ankle swelling which progress over time.1 2 Guidelines recommend that people presenting to primary care with suspected HF should have a natriuretic peptide blood test. If the level is raised, referral for echocardiography and specialist assessment is needed to confirm the diagnosis of HF or determine an alternative cause for the person’s symptoms. However, a first diagnosis of HF is often made in hospital which may be distressing for patients, costly to the health service and usually denotes progression to a later stage of disease. Most patients with HF have seen their general practitioner (GP) prior to receiving a diagnosis and …

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