Do You Have Heart Failure Symptoms?

Posted byGervaisPosted inUncategorized

Missed diagnoses reported as “a scandal”, in Portugal

A scandal in Portugal

Today’s missive from “Medscape”, by Liam Davenport, dated 6/17/24, in which study presenter Lisa Anderson, MD, PhD, of the Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s Hospital, U. London, England, declares “Delays After Test For Suspected Heart Failure A Scandal”.

Only 29% were diagnosed within a year and many, untreated, died.

The original report is from Lisbon, Portugal and the details were explained in a presentation to the Heart Failure Association of the European Society of Cardiology (HFA ESC) 2024 (available online).

The presentation laments that of almost 8,000 people with HF symptoms, seen in outpatient departments over a five-year period, “about two thirds” had suspected heart failure (HF) and only 29% of patients with suspected heart failure received the diagnosis within a year of being seen. This was because the diagnosis was dependent on NT-proBNP (brain natriuretic peptide) testing, followed “within 40 days”, if positive, by “formal echocardiography and specialist clinician assessment” It seems that no doctor dared to offer treatment based on clinical grounds: treatment was given if the diagnosis had not been confirmed by echocardiography.

On the left, a normal heart– on the right, weak muscles have stretched

The failure to diagnose promptly led to a huge liability to morbidity and mortality.

Notably, Dr. Anderson averred that the diagnosis of heart failure “relies on the presentation of patients with nonspecific signs and symptoms, such as dyspnea and peripheral edema”, but “initiation of lifesaving guideline-directed medical therapy has to wait until we have a formal echocardiography and specialist clinician assessment.”

She added that in the United Kingdom, “We are very proud of our 2- and 6-week pathways,” which stipulate that “suspected heart failure patients with NT-proBNP levels between 400 and 2000 ng/L are to have a specialist assessment and transthoracic echocardiography within 6 weeks and that for those with levels > 2000 ng/L, the interval is accelerated to 2 weeks”.

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Published by Gervais

I am a Toronto-trained Urologist. I practiced in downtown Toronto, from 1977 to 1997, when I went to Saudi Arabia as chief of Urology at the Armed Forces (teaching) hospital in Tabuk. Returning to Toronto in Y2000, I switched to family practice. In 2007, began to prescribe Hormone Restoration Therapy and in 2012, I became a member of the American Academy of Antiaging Medicine [A4M]. I successfully wrote the A4M's written examination in December, 2013 and In May, 2016 I passed the oral examination, for accreditation as a BHRT consultant. In 2014 I began BHRT practice in Collingwood, Ontario and in January, 2017, joined the Stone Tree Naturopathic Clinic. Now I am 85 and retired, but it seems wasteful to jettison my learning and experience: the medical establishment knows nothing of BHRT / Functonal medicine and I feel obliged to offer my knowledge in the interest of those who are willing to think outside the box. QUALIFICATIONS: MB, BS, (UWI), 1964. LMCC 1969. FRCSC (Urology), 1974. ECFMG 1984. Florida license [inactive], ABAARM 2016. Affiliations: CSAMM, OMA, CMA, SUSO, CUA, RCP&S/C. PRACTICE TO DATE: Consultation in Functional Medicine: Chronic Fatigue Syndrome, Fibromyalgia, Andropause, Menopause, Teenage and Postpartum Depression/Panic Attacks, Thyroid Hormone malfunction, Infertility, Sexual Dysfunction and “the Undiagnosable”. ALL ARE WELCOME to read, comment or question!