1. Clinical research study implementation of case-finding strategies for heart failure and chronic obstructive pulmonary disease in the elderly with reduced exercise tolerance or dyspnea: A cluster randomized trial
- Author
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Maarten J. Cramer, Frans H. Rutten, Karel G.M. Moons, Aisha Gohar, Johannes B. Reitsma, Yvonne van Mourik, Arno W. Hoes, Jan-Willem J. Lammers, and Loes C.M. Bertens
- Subjects
Male ,Spirometry ,medicine.medical_specialty ,Health Status ,General Practice ,Physical examination ,030204 cardiovascular system & hematology ,law.invention ,Electrocardiography ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Randomized controlled trial ,law ,Health care ,Journal Article ,medicine ,Humans ,Medical history ,030212 general & internal medicine ,Medical History Taking ,Physical Examination ,Aged ,Netherlands ,Heart Failure ,Health Services Needs and Demand ,COPD ,Exercise Tolerance ,medicine.diagnostic_test ,business.industry ,Incidence ,Multimorbidity ,medicine.disease ,Dyspnea ,Echocardiography ,Heart failure ,Quality of Life ,Physical therapy ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Heart failure (HF) and chronic obstructive pulmonary disease (COPD) often remain undiagnosed in older individuals, although both disorders inhibit functionality and impair health. The aim of the study was to assess the effectiveness of a case-finding strategy of these disorders. Methods This is a clustered randomized trial; 18 general practices from the vicinity of Utrecht, the Netherlands, were randomly allocated to a case-finding strategy or usual care. Multimorbid community subjects (≥65 years) with dyspnea or reduced exercise tolerance were eligible for inclusion. The case-finding strategy consisted of history taking, physical examination, blood tests, electrocardiography, spirometry, and echocardiography. Subsequent treatment decisions were at the discretion of the general practitioner. Questionnaires regarding health status and functionality were filled out at baseline and after 6 months of follow-up. Information regarding changes in medication and health care use during the 6 months follow-up was extracted. Results A total of 829 participants were randomized: 389 in the case-finding strategy group and 440 in the usual care group. More patients in the case-finding group received a new diagnosis of HF or COPD than the usual care group (cumulative incidence 34% vs 2% and 17% vs. 2%, respectively). Scores for health status, functionality, and health care use were similar between the 2 strategies after 6 months of follow-up. Conclusions A case-finding strategy applied in primary care to multimorbid older people with dyspnea or reduced exercise tolerance resulted in a number of new diagnoses of HF and COPD but did not result in short-term improvement of health status compared to usual care.
- Published
- 2020
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