Diagnosis, treatment, and follow-up of heart failure patients by general practitioners: A Delphi consensus statement

• Published in: PloS one 2020-12, Vol.15 (12), p.e0244485
• Main Authors: Verhestraeten, Caroline, Weijers, Gijs, Debleu, Daphne, Ciarka, Agnieszka, Goethals, Marc, Droogmans, Steven, Maris, Michael
• Format: Article
• Language: English
• Subjects: Aftercare - standards; Algorithms; Biology and Life Sciences; Cardiologists - standards; Cardiologists - statistics & numerical data; Cardiology; Cardiotonic Agents - administration & dosage; Care and treatment; Congestive heart failure; Consensus; Delphi method; Delphi Technique; Diagnosis; Diuretics; Diuretics - administration & dosage; Dose-Response Relationship, Drug; Drug Administration Schedule; Edema; General Practitioners - standards; General Practitioners - statistics & numerical data; Health services; Heart failure; Heart Failure - diagnosis; Heart Failure - drug therapy; Humans; Medical diagnosis; Medical referrals; Medicine and Health Sciences; Methods; Older people; Parameters; Patient outcomes; Patients; People and Places; Peptides; Practice Guidelines as Topic; Questionnaires; Referral and Consultation - standards; Surveys and Questionnaires - statistics & numerical data; Titration
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0244485

Creation of an algorithm that includes the most important parameters (history, clinical parameters, and anamnesis) that can be linked to heart failure, helping general practitioners in recognizing heart failure in an early stage and in a better follow-up of the patients. The algorithm was created using a consensus-based Delphi panel technique with fifteen general practitioners and seven cardiologists from Belgium. The method comprises three iterations with general statements on diagnosis, referral and treatment, and follow-up. Consensus was obtained for the majority of statements related to diagnosis, referral, and follow-up, whereas a lack of consensus was seen for treatment statements. Based on the statements with good and perfect consensus, an algorithm for general practitioners was assembled, helping them in diagnoses and follow-up of heart failure patients. The diagnosis should be based on three essential pillars, i.e. medical history, anamnesis and clinical examination. In case of suspected heart failure, blood analysis, including the measurement of NT-proBNP levels, can already be performed by the general practitioner followed by referral to the cardiologist who is then responsible for proper diagnosis and initiation of treatment. Afterwards, a multidisciplinary health care process between the cardiologist and the general practitioner is crucial with an important role for the general practitioner who has a key role in the up-titration of heart failure medication, down-titration of the dose of diuretics and to assure drug compliance. Based on the consensus levels of statements in a Delphi panel setting, an algorithm is created to help general practitioners in the diagnosis and follow-up of heart failure patients.