TY - JOUR T1 - The tip of the iceberg: finding patients with heart failure with preserved ejection fraction in primary care. An observational study JF - BJGP Open JO - BJGP Open DO - 10.3399/bjgpopen18X101606 SP - bjgpopen18X101606 AU - Christi Deaton AU - Duncan Edwards AU - Alexandra Malyon AU - M Justin S Zaman Y1 - 2018/09/19 UR - http://bjgpopen.org/content/early/2018/09/18/bjgpopen18X101606.abstract N2 - Background Heart failure with preserved ejection fraction (HFpEF) is under-identified in primary care.Aim The aim of this study was to determine what information is available in patients’ primary care practice records that would identify patients with HFpEF.Design & setting Record review in two practices in east of England.Method Practices completed a case report form on each patient on the heart failure register and sent anonymised echocardiography reports on patients with an ejection fraction (EF) >50%. Reports were reviewed and data analysed using SPSS (version 25).Results One hundred and forty-eight patients on the heart failure registers with mean age 77 +12 years were reviewed. Fifty-three patients (36%) had possible HFpEF based on available information. These patients were older and multimorbid, with a high prevalence of overweight and obesity. Confirmation of diagnosis was not possible as recommended HFpEF diagnostic information (natriuretic peptides, echocardiogram parameters of structural heart disease and diastolic function) was widely inconsistent or absent in these patients.Conclusion Without correct identification of HFpEF, patient management may be suboptimal or inappropriate, and lack the needed focus on comorbidities and lifestyle that can improve patient outcomes. This study describes in detail the characteristics of many of the patients who probably have HFpEF in a real-world sample, and the improvements and diagnostic information required to better identify them. Identifying more than the tip of the iceberg that is the HFpEF population will allow the improvement of the quality of their management, the prevention of ineffective health care, and the recruitment of patients into research. ER -