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. 2020 Dec 31;15(12):e0244485.
doi: 10.1371/journal.pone.0244485. eCollection 2020.

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

Caroline Verhestraeten  1 , Gijs Weijers  2 , Daphne Debleu  1 , Agnieszka Ciarka  3   4 , Marc Goethals  5 , Steven Droogmans  6 , Michael Maris  1
Affiliations

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

Caroline Verhestraeten et al. PLoS One. .

Abstract

Aims: 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.

Methods and results: 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.

Conclusions: 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.

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Conflict of interest statement

The authors have read the journal's policy and have the following Competing Interests to declare: Dr G. Weijers, Dr A. Ciarka, Dr M. Goethals and Dr S. Droogmans received a consultancy fee from Novartis Pharma Belgium for the interpretation of the results, development of the algorithm and review of the manuscript. Michael Maris and Caroline Verhestraeten are employees of Novartis Pharma Belgium. Daphné Debleu was doing an internship during the development of this project at Novartis Pharma Belgium. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Algorithm for diagnosis and follow-up of HF patients.
See this image and copyright information in PMC

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