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

TL;DR

This study found that general practitioners specialized in cardiovascular disease are more likely to consider heart failure tests in patients with respiratory symptoms than non-specialists.

Contribution

The study demonstrates that cardiovascular-specialized GPs are more inclined to order heart failure-specific diagnostic tests in ambiguous clinical scenarios.

Findings

GPSI-CVD were more likely to order ECG in the first vignette (64.0% vs. 32.5%).

In the second vignette, GPSI-CVD were more likely to order both ECG and natriuretic peptide testing.

Most GPs considered multiple diagnoses, but specialists prioritized heart failure testing.

Abstract

General practitioners (GPs) specialized in cardiovascular disease (GPSI-CVD) may suspect heart failure (HF) more easily than GPs not specialized in CVD. We assessed whether GPSI-CVD consider investigations aimed at detecting HF more often than other GPs in two clinical scenarios of an older male person with respiratory and suggestive HF symptoms.

In this vignette study, Dutch GPs evaluated two vignettes. The first involved a 72-year-old man with hypertension and a 30 pack-year smoking history who presented himself with symptoms of a common cold, but also shortness of breath, reduced exercise tolerance, and signs of fluid overload. The second vignette was similar but now the 72-year-old man was known with chronic obstructive pulmonary disease (COPD).

GPs could select diagnostic tests from a multiple-choice list with answer options targeted at HF, COPD or exacerbation of COPD, or lower respiratory tract infection. With Pearson Chi-square or Fisher’s exact test differences between the two GP groups were assessed regarding the chosen diagnostic tests.

Of the 148 participating GPs, 25 were GPSI-CVD and 123 were other GPs. In the first vignette, GPSI-CVD more often considered performing electrocardiography (ECG) than other GPs (64.0% vs. 32.5%, p = 0.003). In the second vignette, GPSI-CVD were more inclined to perform both ECG (36.0% vs. 12.2%, p = 0.003) and natriuretic peptide testing (56.0% vs. 32.5%, p = 0.006).

Most GPs seemed to consider multiple diagnoses, including HF, with GPSI-CVD more likely performing ECG and natriuretic peptide testing in an older male person with both respiratory and suggestive HF symptoms.

The online version contains supplementary material available at 10.1186/s12875-024-02466-6.