Result card

  • CUR13: How is the disease or health condition currently diagnosed according to published guidelines and in practice?
English

How is the disease or health condition currently diagnosed according to published guidelines and in practice?

Authors: Ingrid Wilbacher, Nadine Berndt, Francesca Gillespie

Internal reviewers: Alessandra Lo Scalzo, Christian Vladescu, Christina Mototolea, Kristina Lampe, Maria Camerlingo

Basis search was not sufficient and a search (mainly on Medline) of all available guidelines in English was done. No quality assessment of guidelines was done. Focus was made on diagnosis indications within the reviewed guidelines.

Most guidelines agree on three essential stages of care for patients with heart failure:

-Diagnosis (should be timely and accurate);

-Treatment (should be appropriate to each patient and available urgently if necessary);

-Longterm management (should include follow-up, monitoring and support).

Disagreement is observed on which diagnostic tools should be used for all patients with suspected heart failure and in which order.

Especially for invasive diagnostics there are some differences and challenges according to the interpretation of the diagnostic and prognostic value {45}

The Global heart failure Awareness Programme {45} reported that many guidelines have been published [North America (Canada: CCS and USA: ACCF/AHA, HFSA), Europe (England and Wales: NICE, France: HAS, Germany: DEGAM, Scotland: SIGN) and Aia (Japan: JSC, Singapore: MoH) for heart failure patients and although they may differ in what evidence is included and how it is assessed and in what is considered appropriate, the all agree on three essential stages of care for patients with heart failure: diagnosis (should be timely and accurate)-treatment (should be appropriate to each patient and available urgently if necessary)-longterm management (should include follow-up, monitoring and support. They state that an international consensus recommendation leading to greater clarity about best practice with endorsement from credible local bodies would be of help. Although published guidelines agree on which diagnostic tools are useful, they disagree on which should be used for all patients with suspected heart failure and in which order. Making an accurate diagnosis requires a range of diagnostic tools, in conjunction with clinical judgement and expert knowledge.

The ESC guidelines {77} highlight particular challenges related to diagnosis of HF-PEF (heart failure with ‘preserved’ ejection fraction) remains a particular challenge, and the optimum approach incorporating symptoms, signs, imaging, biomarkers, and other investigations is uncertain. The following questions are posed: Strain/speckle imaging—value in diagnostic and prognostic assessment of both HF-REF (heart failure with reduced ejection fraction) and HF-PEF? Diastolic stress test—value in diagnosis of HF-PEF?

A recent Australian consensus statement {88} recognizes that many individuals are not diagnosed in a timely manner, and once a diagnosis is made, treatment is frequently sub-optimal.

Important
Partially
Wilbacher I et al. Result Card CUR13 In: Wilbacher I et al. Health Problem and Current Use of the Technology In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 21 June 2021]. Available from: http://corehta.info/ViewCover.aspx?id=305

References