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Heart failure diagnosis in primary health care: clinical characteristics of problematic patients. A clinical judgement analysis study.

Skånér Y, Bring J, Ullman B, Strender LE - BMC Fam Pract (2003)

Bottom Line: Early detection of chronic heart failure has become increasingly important since the introduction of effective treatment.The purpose of this study is to analyse how patient characteristics contribute to difficulties in diagnosing systolic heart failure. A Clinical Judgement Analysis study of 40 case vignettes based on authentic patients, including relevant clinical data except echocardiography.Primary health care and two cardiology outpatient clinics in Stockholm. 70 participants with different types of clinical experience; 27 specialists in general practice, 22 cardiologists, and 21 medical students.

View Article: PubMed Central - HTML - PubMed

Affiliation: Family Medicine Stockholm, Karolinska Institutet, Alfred Nobels allé 12, SE-141 83 Huddinge, Sweden. ylva.skaner@klinvet.ki.se

ABSTRACT

Background: Early detection of chronic heart failure has become increasingly important since the introduction of effective treatment. However, clinical diagnosis of heart failure is known to be difficult, especially in mild cases or early in the course of the disease. The purpose of this study is to analyse how patient characteristics contribute to difficulties in diagnosing systolic heart failure.

Design: A Clinical Judgement Analysis study of 40 case vignettes based on authentic patients, including relevant clinical data except echocardiography.

Setting: Primary health care and two cardiology outpatient clinics in Stockholm.

Subjects: 70 participants with different types of clinical experience; 27 specialists in general practice, 22 cardiologists, and 21 medical students.

Main outcome measures: The assessed probability of heart failure for each case vignette, and the disagreement between the participants. The number of clinical variables (cues) indicative of heart failure in the case vignettes.

Results: The ten case vignettes with the least diverging assessments more often had increased relative cardiac volume and atrial fibrillation. No further specific clinical patterns could be found in subgroups of the case vignettes. The ten case vignettes with the most diverging assessments were those with an intermediate number of clinical variables. The case vignettes with the least diverging assessments more often represented patients with cardiac enlargement and atrial fibrillation.

Conclusion: Diagnosing mild heart failure is difficult, as these patients are not easy to characterise. In our study, a larger number of positive cues resulted in more diagnostic conformity among the participants, and the most important information was cardiac enlargement. The importance of more objective diagnostic methods in diagnosing suspected cases of heart failure should be emphasised.

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Related in: MedlinePlus

Association between assessment divergency and number of positive cues. A regression line plot representing the association between the interquartile range values (degree of assessment divergency) and the number of positive cues for the 40 case vignettes.
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Figure 2: Association between assessment divergency and number of positive cues. A regression line plot representing the association between the interquartile range values (degree of assessment divergency) and the number of positive cues for the 40 case vignettes.

Mentions: The regression line plot indicates that the case vignettes with the least divergent assessments were those with the highest and the lowest number of positive cues, and the case vignettes with the most divergent assessments were those with an intermediate number of positive cues (Fig. 2).


Heart failure diagnosis in primary health care: clinical characteristics of problematic patients. A clinical judgement analysis study.

Skånér Y, Bring J, Ullman B, Strender LE - BMC Fam Pract (2003)

Association between assessment divergency and number of positive cues. A regression line plot representing the association between the interquartile range values (degree of assessment divergency) and the number of positive cues for the 40 case vignettes.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC222938&req=5

Figure 2: Association between assessment divergency and number of positive cues. A regression line plot representing the association between the interquartile range values (degree of assessment divergency) and the number of positive cues for the 40 case vignettes.
Mentions: The regression line plot indicates that the case vignettes with the least divergent assessments were those with the highest and the lowest number of positive cues, and the case vignettes with the most divergent assessments were those with an intermediate number of positive cues (Fig. 2).

Bottom Line: Early detection of chronic heart failure has become increasingly important since the introduction of effective treatment.The purpose of this study is to analyse how patient characteristics contribute to difficulties in diagnosing systolic heart failure. A Clinical Judgement Analysis study of 40 case vignettes based on authentic patients, including relevant clinical data except echocardiography.Primary health care and two cardiology outpatient clinics in Stockholm. 70 participants with different types of clinical experience; 27 specialists in general practice, 22 cardiologists, and 21 medical students.

View Article: PubMed Central - HTML - PubMed

Affiliation: Family Medicine Stockholm, Karolinska Institutet, Alfred Nobels allé 12, SE-141 83 Huddinge, Sweden. ylva.skaner@klinvet.ki.se

ABSTRACT

Background: Early detection of chronic heart failure has become increasingly important since the introduction of effective treatment. However, clinical diagnosis of heart failure is known to be difficult, especially in mild cases or early in the course of the disease. The purpose of this study is to analyse how patient characteristics contribute to difficulties in diagnosing systolic heart failure.

Design: A Clinical Judgement Analysis study of 40 case vignettes based on authentic patients, including relevant clinical data except echocardiography.

Setting: Primary health care and two cardiology outpatient clinics in Stockholm.

Subjects: 70 participants with different types of clinical experience; 27 specialists in general practice, 22 cardiologists, and 21 medical students.

Main outcome measures: The assessed probability of heart failure for each case vignette, and the disagreement between the participants. The number of clinical variables (cues) indicative of heart failure in the case vignettes.

Results: The ten case vignettes with the least diverging assessments more often had increased relative cardiac volume and atrial fibrillation. No further specific clinical patterns could be found in subgroups of the case vignettes. The ten case vignettes with the most diverging assessments were those with an intermediate number of clinical variables. The case vignettes with the least diverging assessments more often represented patients with cardiac enlargement and atrial fibrillation.

Conclusion: Diagnosing mild heart failure is difficult, as these patients are not easy to characterise. In our study, a larger number of positive cues resulted in more diagnostic conformity among the participants, and the most important information was cardiac enlargement. The importance of more objective diagnostic methods in diagnosing suspected cases of heart failure should be emphasised.

Show MeSH
Related in: MedlinePlus