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Does the physical examination still have a role in patients with suspected heart failure?

Damy, Thibaud; Kallvikbacka-Bennett, Anna; Zhang, Jufen; Goode, Kevin; Buga, Laszlo; Hobkirk, James; Yassin, Ashraf; Dubois-Randé, Jean-Luc; Hittinger, Luc; Cleland, John G. F.; Clark, Andrew L.

Authors

Jean Luc Dubois-Rand

Jean-Luc Dubois-Rande

Thibaud Damy

John G. F. Cleland

Andrew L. Clark

John G.F. Cleland

Anna Kallvikbacka-Bennett

Jufen Zhang

Kevin Goode K.M.Goode@hull.ac.uk

Laszlo Buga

Ashraf Yassin

Jean-Luc Dubois-Randé

Luc Hittinger

Abstract

AIMS: The prognostic value of signs of congestion in patients suspected of having chronic heart failure (CHF) is unknown. Our objectives were to define their prevalence and specificity in diagnosing CHF and to determine their prognostic value in patients in a community heart failure clinic. METHODS AND RESULTS: Analysis of referrals to a community clinic for patients with CHF symptoms. Systolic CHF (S-HF) was defined as left ventricular ejection fraction (LVEF) </=45%, heart failure with normal ejection fraction (HeFNEF) as LVEF > 45%, and amino-terminal pro-brain natriuretic peptide >50 pmol L(-1); other subjects were defined as not having CHF. Signs of congestion were as follows: no signs; right heart congestion (RHC: oedema, jugular venous distension); left heart congestion (LHC: lung crackles); or both (R + LHC). Of 1881 patients referred, 707 did not have CHF, 853 had S-HF, and 321 had HeFNEF. The median inter-quartile range (IQR) age was 72 years (64-78), 40% were women, and LVEF was 47% (35-59). Overall, 417 patients had RHC of whom 49% had S-HF and 21% HeFNEF. Eighty-five patients had LHC of whom 43% had S-HF and 20% had HeFNEF. One hundred and seventy-two patients had R + LHC of whom 71% had S-HF and 16% had HeFNEF. During a median (IQR) follow-up of 64(44-76) months, 40% of the entire patient cohort died. The combination of R + LHC signs was an independent marker of an adverse prognosis (chi(2)-log-rank test = 186.1, P< 0.0001). CONCLUSION: Clinical signs of congestion are independent predictors of prognosis in ambulatory patients with suspected CHF

Journal Article Type Article
Publication Date 2011-12
Journal EUROPEAN JOURNAL OF HEART FAILURE
Print ISSN 1388-9842
Electronic ISSN 1879-0844
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 13
Issue 12
Pages 1340-1348
DOI https://doi.org/10.1093/eurjhf/hfr128
Keywords Chronic heart failure; Physical examination; Prognosis; Congestion