Adherence to guidelines in management of symptoms suggestive of heart failure in primary care
Adherence to guidelines in management of symptoms suggestive of heart failure in primary care
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DOI：
10.1136/heartjnl-2018-313971
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发表时间：
2019-05-01
期刊：
影响因子：
5.7
通讯作者：
Bottle, Alex
中科院分区：
文献类型：
--
作者：
Hayhoe, Benedict;Kim, Dani;Bottle, Alex
目的心力衰竭临床指南建议在初级保健中进行调查和转诊的时机。我们计算了患者达到心衰诊断推荐途径中关键要素所需的时间。在这项观察性研究中，我们使用了2010年至2013年间的初级和二级医疗数据（临床实践研究数据链，一个来自英国全科医生的匿名电子记录数据库）。检查记录的表现症状（呼吸困难、疲劳、踝关节肿胀）和国家卫生与保健研究所推荐的诊断途径的关键要素（血清利钠肽（NP）试验、超声心动图、专家转诊）。结果42 403例患者被诊断为HF，其中16 597例就诊时伴有提示症状。6464例（39%）有NP或超声心动图记录，6043例（36%）有专科转诊。从记录症状到调查（NP或超声心动图）的中位时间为292天（IQR 34-844），到转诊236天（IQR 42-721）。从症状到诊断的中位时间为972天（IQR 337-1468），到接受hf相关药物治疗的中位时间为803天（IQR 230-1364）。影响转诊时间、治疗和诊断的显著因素包括患者的性别（p=0.001）、年龄（p=0.001）
Objective Clinical guidelines on heart failure (HF) suggest timings for investigation and referral in primary care. We calculated the time for patients to achieve key elements in the recommended pathway to diagnosis of HF.Methods In this observational study, we used linked primary and secondary care data (Clinical Practice Research Datalink, a database of anonymised electronic records from UK general practices) between 2010 and 2013. Records were examined for presenting symptoms (breathlessness, fatigue, ankle swelling) and key elements of the National Institute for Health and Care Excellence-recommended pathway to diagnosis (serum natriuretic peptide (NP) test, echocardiography, specialist referral).Results 42 403 patients were diagnosed with HF, of whom 16 597 presented in primary care with suggestive symptoms. 6464 (39%) had recorded NP or echocardiography, and 6043 (36%) specialist referral. Median time from recorded symptom(s) to investigation (NP or echocardiography) was 292 days (IQR 34-844) and to referral 236 days (IQR 42-721). Median time from symptom(s) to diagnosis was 972 days (IQR 337-1468) and to treatment with HF-relevant medication 803 days (IQR 230-1364). Factors significantly affecting timing of referral, treatment and diagnosis included patients' sex (p=0.001), age (p