What’s new in diagnosis: Is there a clear diagnostic pathway? What’s new in diagnosis: Is there a clear diagnostic pathway?

Heart failure can present with non-specific symptoms such as fatigue or reduced exercise tolerance. ‘Patients in primary care are more likely to be elderly with multiple comorbidities and gradual onset of symptoms is more common’, said Dr Frans Rutten (Utrecht, Netherlands). ‘Patients with acute onset breathlessness are more likely to present to the emergency department’. The European Society of Cardiology guidelines on diagnosis and management of heart failure recognise this distinction. ECG, chest–xray and natriuretic peptides can help in ruling out a diagnosis of heart failure however echocardiogram remains the most commonly used investigation for making a definitive diagnosis of heart failure in clinical practice. ‘Can a diagnostic and treatment pathway be solely in the hands of the primary care physician?’ asked one delegate. ‘GPs are more able than they think they are……if heart failure is slow in onset and there are no reversible causes, then there is no reason why GPs cannot manage the patient’, said Dr Rutten. Primary care is well placed to carefully manage the interplay between co-morbidity and compliance. Co-morbidities make diagnosis more difficult, worsen prognosis and limit therapeutic options. As generalists GPs are used to dealing with these challenges.

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