Potential Overuse or Misuse of Diagnosis of Heart Failure

A study in the Journal of American Medical Association draws our attention to heart failure in patients with normal left ventricular systolic function. The symptoms of heart failure can be due to weak heart muscles or inability of the heart muscles to relax. The former is called systolic heart failure while the later is called diastolic heart failure. Various studies have shown prevalence of diastolic heart failure (in the absence of weak heart muscles) to be up to 50%. The recognition of an entity called diastolic heart failure some years back was a good development. Prior to that, the medical community would not think of a diagnosis of heart failure in patients that had normal heart function on echocardiogram. The recognition of diastolic heart failure however brings following challenges with it:
It is easy to start treating for heart failure once weak heart function is recognized. Moreover, it is important to recognize systolic heart failure because we have definitive treatment available for this disease. Diagnosing systolic heart failure is also easy. Very simple procedures like echocardiogram can do it. On the other hand, diagnosing diastolic heart failure is difficult. Several diagnostic methods have been devised. Several of them are in the process of being validated.
The diagnosis of heart failure itself is not always easy. A shortness of breath or edema of the legs can be due to several causes including heart failure. The diagnosis of diastolic heart failure involves two steps; the diagnosis of heart failure and that of diastolic dysfunction. In the absence of foolproof criteria for the diagnosis of heart failure and diastolic dysfunction, some people can be wrongly given this diagnosis. If we are not careful, it has the potential of being the convenient diagnosis for a lot of symptoms. We saw this kind of overuse of the diagnoses mitral valve prolapse (MVP) and MVP syndrome some years ago.
The effective treatment of diastolic heart failure is the treatment of its causes including diabetes, high blood pressure and disease of heart arteries. Should we not be treating them aggressively any way?

Pragmatic action points:
- It is important to be aware of diastolic heart failure as a clinical entity. But it is important not to use it as an easy explanation for most of our patients’ symptoms. Other more easily treatable causes of the symptoms that can be confused with diastolic heart failure should be sought.
- We should focus on optimal treatment of the diseases that cause diastolic heart failure regardless of the presence of diastolic heart failure.
- It is very important to keep seeking better treatment measures for this disease. However, we need to be aware of potential misuse of this diagnosis.
Home Page Back to Blog

Outsourcing Medical Care

Kevin, MD and Dr. Wes recently talked about healthcare outsourcing. They talk about Americans going to other countries to seek medical care. The responses to their posts are a good gauge of emotions that this issue stirs.
Two or three days back, I heard an advertisement on the radio about some kind of heart procedure that is not approved in the US. The advertisement was offering that procedure in Singapore or Thailand. Things like this make people like me practicing medicine in the US nervous for our patients.
I have talked with several people about getting prescription drugs from other countries. Appeal to citizens’ nationalism and plea to support research in the US are some of the tactics that have been tried to prevent people from buying drugs from abroad. More than a few people told me that when it is a choice between eating and buying medicines, supporting pharmaceutical research is the last thing on their mind.
In a market place, Bloomingdale’s can be as proud of its quality as it wants. However, if most of the buyers choose to go to Wal-Mart, that is where they go. In this day and age, the world is turning into a big mall. If there is a product being sold at 40% off on the east end of the mall, that is where people will go. The customers do need to know more about this new concept of medical care abroad, so that they can be good judges of quality. Posts on Kevin, MD and Dr. Wes bring up challenges that come with seeking medical care abroad.
As health care providers, we work hard to give our patients the best possible care, and it is hard for us to fathom why some people would choose to seek medical care that seemingly is held to no standards. This is far beyond losing business to foreign competitors. It is personal, as we give far more than 100% to our profession. But if some of our patients are forced to choose between health care and financial health, they may decide to have both. And going abroad may seem like a great option to them.
The question is what can we do? How we can we stem this tide?
Home Page