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• Diagnosis of heart failure in primary care: the syndrome and the spectrum
  Claudia Fotzeu
  Published on: 30 November 2010

• Published on: 30 November 2010

  Diagnosis of heart failure in primary care: the syndrome and the spectrum

  • Claudia Fotzeu, Assistant Professor of Medicine

  To the Editor: I read with great interest the article by Hobbs et al. [1] I commend the authors for their original review of the diagnosis of heart failure in primary care. Heart failure as defined by current guidelines published by professional societies in North America[2] and Europe[3] is a syndrome in which patients must have both typical signs and symptoms of heart failure and objective evidence of structural or functional a...

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  To the Editor: I read with great interest the article by Hobbs et al. [1] I commend the authors for their original review of the diagnosis of heart failure in primary care. Heart failure as defined by current guidelines published by professional societies in North America[2] and Europe[3] is a syndrome in which patients must have both typical signs and symptoms of heart failure and objective evidence of structural or functional abnormality. I agree with the conclusion that this clinical syndrome may be difficult for a primary care physician to diagnose accurately particularly if the symptoms develop slowly and are not as severe as to warrant immediate hospitalization. I also agree with the key point that early diagnosis can favorably alter prognosis and mortality. However, I would like to emphasize that heart failure is also a disease spectrum with four stages as highlighted in the current AHA classification.[2] Stage A - Patients at risk asymptomatic without structural or functional abnormality. Stage B - Patients with structural abnormality but without signs or symptoms. Stage C - Patient with structural abnormality with current or prior signs or symptoms. Stage D - Patients with refractory heart failure requiring specialized interventions. This staging system recognizes that Heart Failure has established risk factors and structural prerequisites; that the development of Heart Failure has asymptomatic and symptomatic phases; and that specific treatments targeted at each stage can reduce the morbidity and mortality of Heart Failure.[2] Therefore, if priority is given to diagnosing the initial stages of Heart Failure, the complexity of the diagnosis will be lessened to some extent. Improving cardiovascular health and quality of life through the prevention, detection, and treatment of risk factors; and reducing hospitalizations of older adults with heart failure as the principal diagnosis are essential objectives of Healthy People 2020.[4] Do you then agree that diagnosing the first two stages or in other words asymptomatic heart failure should be the priority of the primary care physician?

  References

  1 Hobbs FD, Doust J, Mant J, et al. Heart failure: Diagnosis of heart failure in primary care. Heart. 2010 Nov;96(21):1773-7.

  2 Hunt SA et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2005 Sep 20;46(6):e1-82.

  3 Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail. 2008 Oct;10(10):933-89.

  4 Healthy People 2020. Accessed on www.healthypeople.gov/hp2020/Objectives/TopicArea.aspx?id=28&TopicArea=Heart Disease and Stroke on October 25, 2010.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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