The diagnosis of XXXX in general practice: implications for the UK National Service Framework.

@entity1 @entity712 @entity1002
BACKGROUND: The UK National Service Framework recommends @entity1 with suspected @entity712 undergo echocardiography. Selection of @entity1 for this investigation in primary care is difficult. It is not clear which clinical features best identify @entity1 with @entity1002 . AIM: Using echocardiography, to establish the accuracy of primary care diagnosis of @entity1002 . To investigate the sensitivity, specificity and predictive values of clinical features in the diagnosis of @entity1002 . STUDY: A cross-sectional study of 621 @entity1 from a population prescribed loop diuretics in 7 general practices. METHOD: Clinical diagnoses were extracted from general practice records. Symptoms, clinical signs, ECG features, brain natriuretic peptide levels and echocardiographic findings were studied in a research clinic. RESULTS: @entity1002 (ejection fraction <40%) was present in 50% of 621 @entity1 prescribed loop diuretics in primary care. General practice diagnoses showed high false positive rates. Individual or combinations of clinical features did not accurately predict @entity1002 . CONCLUSION: These results suggest the clinical diagnosis of @entity1002 is inaccurate in this population. General practitioners should have a low threshold for referring @entity1 prescribed loop diuretics for echocardiography. Increased open access echocardiography facilities will be needed.
