Thursday, May 29, 2008

European docs aren’t adhering to evidence based heart failure strategies

---according to this paper in the European Heart Journal, anyway. Although at the bottom of the paper is says “Conflict of interest: none declared” I suspect the authors represent subspecialists who have an interest in heart failure patients being referred to them and in cardiac imaging being performed.

DB’s Medical Rants offers a useful perspective on the issue. I would only add that the BBC News piece which covered the story got it wrong about echocardiography. A caption reads: “An echocardiogram should be used to confirm heart failure.” Wrong. An echo is indicated to classify heart failure, better understand the patient’s cardiac anatomy and physiology and guide treatment, not to diagnose or confirm. The ACC guidelines say this about diagnosing heart failure:

It should be emphasized that HF is not equivalent to cardiomyopathy or to LV dysfunction; these latter terms describe possible structural or functional reasons for the development of HF. Instead, HF is defined as a clinical syndrome that is characterized by specific symptoms (dyspnea and fatigue) in the medical history and signs (edema, rales) on the physical examination. There is no single diagnostic test for HF because it is largely a clinical diagnosis that is based on a careful history and physical examination.

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