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Research

Prognosis following a diagnosis of heart failure and the role of primary care: a review of the literature

Nicholas R Jones, FD Richard Hobbs and Clare J Taylor
BJGP Open 2017; 1 (3): bjgpopen17X101013. DOI: https://doi.org/10.3399/bjgpopen17X101013
Nicholas R Jones
1 GP Trainee & Academic Clinical Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford, , UK
MBBS, MClinEd, FHEA
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FD Richard Hobbs
2 GP & Professor of Primary Care, Nuffield Department of Primary Care Health Sciences, University of Oxford, , UK
FRCP, FESC, FRCGP, FMedSci
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Clare J Taylor
3 GP & NIHR Academic Clinical Lecturer, Nuffield Department of Primary Care Health Sciences, University of Oxford, , UK
MA, MPH, PhD, FRCGP
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  • For correspondence: clare.taylor{at}phc.ox.ac.uk
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    Figure 1. Changes in age-standardised prescribing rates between 1996 & 2003. 15  ACE = angiotensin converting enzyme.

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    Table 1. Survival rates in chronic heart failure
    StudySettingTotal participantsParticipants with HFCountryAverage age at outset, years1-year survival, %2-year survival, %5-year survival, %10-year survival, %
    Mosterd et al 2001 5 Participants from Rotterdam population study screened for diagnosis or symptoms of HF5255181The Nether-lands68.9897959–
    Nielsen et al 2003 6 Cross-sectional sample from three general practices, screened for participants with diagnosis or symptoms of HF2157
    including control group (571) and heart disease but no HF (218)
    67 with community managed HF:
    33 in hospital managed HF comparator
    Denmark74.1–
    –
    61–
    Hobbs et al 2007 7 Participants from UK general practice screened for HF6162
    including 1062 at high risk for HF and 982 on diuretics at baseline
    Previous clinical label of HF ( 782)UK64.2–
    –
    63–
    Tsutsui et al 2007 8 Data from The Cardiac Registry of Heart Failure in General Practice26851280 followed-up in hospital and 1405 by GPJapan7490.9–
    –
    –
    Pons et al 2010 9 Consecutive sample from outpatient HF clinic960All followed-up in outpatient cardiology clinicSpain6989.4–
    –
    –
    Taylor et al 2012 10 As per Hobbs et al 2007 paper: 7 10-year follow-up of ECHOES cohortSee aboveSee aboveUK64.2–
    –
    –
    26.7
    Taylor et al 2017 11 Survival analysis using UK primary care records from The Health Improvement Network54 313All with first diagnosis of HFUK76.581.3–
    51.529.5
    • ECHOES = Echocardiographic Heart of England Screening (ECHOES). HF = heart failure.

    • View popup
    Table 2. Survival rates in acute heart failure
    StudyParticipantsTotal participantsCountryAverage age, years30 day survival, %1-year survival, %3-year survival, %5-year survival, %6-year survival, %
    Blackledge et al 2003 12 Following admission to hospital with first episode of HF12 220UK76.879.157.138.92723.2
    Nielsen et al 2003 6 Cross-sectional sample from three general practices, screened for participants with diagnosis or symptoms of HF2157:
    33 in hospital HF group; 67 in GP-managed HF; control group (571) and heart disease but no HF (218)
    Denmark74.1–
    –
    –
    39–
    Goldberg et al 2007 13 Recruited from 11 sites following admission with acute HF2445US76–
    62.7–
    21.5–
    Ko et al 2008 14 Recruited following first admission with HF9943Canada75.8–
    66.9–
    31.3–
    Jhund et al 2009 15 Every admission with first episode of HF in Scotland during study period116 556Scotland70.780.855.8–
    26–
    Parenica et al 2013 16 Recruited from seven sites following admission with acute HF4153Czech Republic72.882.879.764.5–
    –
    • HF = heart failure.

    • View popup
    Box 1. European Society of Cardiology heart failure categories by ejection fraction 3
    Category of heart failureAbbreviationLeft ventricular ejection fraction, %Additional criteria to meet diagnosis
    Heart failure with reduced ejection fractionHFrEF<40Not required
    Heart failure with mid-range ejection fractionHFmrEF40–49Elevated levels of natriuretic peptides and either relevant structural heart disease or diastolic dysfunction
    Heart failure with preserved ejection fractionHFpEF≥50Elevated levels of natriuretic peptides and either relevant structural heart disease or diastolic dysfunction
    • View popup
    Box 2. New York Heart Association classification
    NYHA ClassDefinition
    INo limitations of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnoea
    IISlight limitation of physical activity. Patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, breathlessness, or angina pectoris
    IIIMarked limitation of physical activity. Although patients are comfortable at rest, less than ordinary activity will lead to symptoms
    IVInability to carry out any physical activity without discomfort. Symptoms of congestive cardiac failure are present even at rest. Increased discomfort with any physical activity
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Prognosis following a diagnosis of heart failure and the role of primary care: a review of the literature
Nicholas R Jones, FD Richard Hobbs, Clare J Taylor
BJGP Open 2017; 1 (3): bjgpopen17X101013. DOI: 10.3399/bjgpopen17X101013

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Prognosis following a diagnosis of heart failure and the role of primary care: a review of the literature
Nicholas R Jones, FD Richard Hobbs, Clare J Taylor
BJGP Open 2017; 1 (3): bjgpopen17X101013. DOI: 10.3399/bjgpopen17X101013
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  • Article
    • Acute and chronic heart failure
    • Preserved and reduced ejection fraction
    • Other negative prognostic indicators
    • Prescribing in HF
    • Causes of death
    • Mortality differences over time
    • Discussing prognosis and HF trajectory
    • Conclusion
    • Provenance
    • Notes
    • References
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Keywords

  • heart failure
  • Prognosis
  • Primary care

More in this TOC Section

  • English general practice in a period of change: a mixed-methods study of staff and patient perspectives
  • Strengthening integration of pathways into general practice in Australia: a virtual workshop study with stakeholders
  • Ethnicity and clinical empathy in primary care consultations: a web-based experiment
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