The following is a summary of “Comparing the diagnostic considerations between general practitioners with a special interest in cardiovascular disease and those without in patients with symptoms suggestive of heart failure: a vignette study,” published in the June 2024 issue of Primary Care by Vermeer et al.

This study investigates how general practitioners (GPs) specialized in cardiovascular disease (GPSI-CVD) differ in their diagnostic considerations compared to other GPs when presented with scenarios suggestive of heart failure (HF). Researchers aimed to assess whether GPSI-CVD is more inclined to consider investigations to detect HF in two clinical vignettes featuring an older male patient presenting with respiratory symptoms indicative of HF.

Dutch GPs participated in a vignette-based study where they evaluated two clinical scenarios. The first scenario depicted a 72-year-old man with hypertension and significant smoking history, presenting with symptoms of a cold alongside shortness of breath, reduced exercise tolerance, and signs of fluid overload. The second scenario was similar but included a known history of chronic obstructive pulmonary disease (COPD).

GPs selected diagnostic tests from a multiple-choice list targeting HF, COPD exacerbation, or lower respiratory tract infection. Differences between GPSI-CVD and other GPs in diagnostic test selection were analyzed using Pearson Chi-square or Fisher’s exact tests.

Among the 148 participating GPs, 25 were GPSI-CVD, and 123 were other GPs. In the first vignette, GPSI-CVD more frequently considered performing electrocardiography (ECG) compared to other GPs (64.0% vs. 32.5%, p = 0.003). In the second vignette, GPSI-CVD were more likely to opt for both ECG (36.0% vs. 12.2%, p = 0.003) and natriuretic peptide testing (56.0% vs. 32.5%, p = 0.006).

This study suggests that while most GPs consider multiple diagnostic possibilities, GPSI-CVD are more proactive in considering HF-specific investigations such as ECG and natriuretic peptide testing when faced with older male patients presenting respiratory symptoms suggestive of HF. These findings highlight the potential benefit of cardiovascular specialization in enhancing early detection and management of HF in primary care settings.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02466-6