A Rapid Access Heart Failure Clinic provides a prompt diagnosis and appropriate management of new heart failure presenting in the community

Background and aims: The diagnosis of hl:art failure is an important clinic al problem and yet reported diagnostic accuracy in primary care is less tha n 50%. We established a Rapid Access Heart Failure Clinic (RAHFC) in a dist rict general hospital serving a population of 292 000 in SE London, UK, to diagnose and manage new cases of heart failure presenting for the first tim e in the community. Methods: Patients with suspected new onset heart failur e were referred by their Primary Care Physician without appointment for cli nical. assessment on the same or next working day. Assessment by a speciali st registrar in cardiology included history, examination, chest X-ray, elec trocardiogram (ECG) and echocardiogram. When a diagnosis of heart failure w as made appropriate treatment, including angiotensin converting enzyme inhi bitors (ACEI), was started. Results: Over 15 months 383 patients were seen (0.4 cases/100 000 population/weekday) 178/383 (46%) were considered to hav e definite or possible heart failure at the initial assessment in the RAHFC . A normal ECG (negative predictive value 94%) and chest X-ray virtually ex cluded the diagnosis of heart failure. After subsequent specialist investig ations and follow-up, including a trial of therapy where appropriate, 101/3 83 (26%) were finally diagnosed as clinical heart failure. ACEI therapy was commenced in 56/57 (98%) of patients in whom it was considered appropriate . Conclusion: The RAHFC provided rapid assessment, prompt diagnosis and ear ly introduction of life prolonging therapy for patients presenting with sus pected heart failure in the community. (C) European Society of Cardiology. All rights reserved.