Patients in primary health care diagnosed and treated as heart failure, with special reference to gender differences

Objective -The aim of the present study was to describe patients considered to have had heart failure (HF), or were being treated for HF, in a defined area in primary health care, e.g. diagnostic procedures, aetiologic diseas es and management, and to evaluate whether there is a difference between th e genders. Design - Descriptive retrospective investigation. Setting - Atvidaberg community situated in southeast Sweden, 12 400 inhabit ants. Patients - 256 patients treated for symptomatic HF. Main outcome measures - Prevalence, aetiology, diagnostic procedures and ma nagement of HF and differences between the genders. Results - The diagnosis of HF was based on an objective evaluation of cardi ac function in only 31% of the patients. Ischaemic heart disease (IHD) was the predominant associated disease, followed by hypertension. Therapy inclu ded diuretics (84%), angiotensin converting enzyme (ACE) inhibitors (56%) a nd digoxin (40%). Only 52% had optimal doses of ACE inhibitors. Women had a significantly higher mean age and their diagnoses were based on an objecti ve diagnostic test (echocardiography) in only 20%. Women were prescribed AC E inhibitors to a lesser extent (43%) than men (64%) and with a lower optim al dose (44% versus 56% in men). Conclusion - There is still room for improvement in the management of HF in primary health care, especially in women, where the diagnosis is not gener ally based on an objective evaluation of cardiac function and where the tre atment to a lesser extent than in men includes ACE inhibitors.