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Title: Patient History, Physical Exam as Effective as High-Tech Approaches in Assessing Patients With CHF
URL: http://www.pslgroup.com/dg/22CA0A.htm
Doctor's Guide
September 17, 2008

DALLAS -- September 17, 2008 -- Patient history and physical examination may still be among the most accurate and cost-efficient methods to assess patients with congestive heart failure, according to a study in the September 16 issue of Circulation: Heart Failure.

Such time-honoured techniques have diminished in importance in recent years as physicians have come to rely on high-tech diagnostic approaches, such as imaging and measuring biomarkers.

"There has been a shift away from the use of the history and physical examination in patient care," said lead author Mark Drazner, MD, Heart Failure and Cardiac Transplantation Program, Southwestern University Medical Center, Dallas, Texas.

Dr. Drazner and colleagues sought to determine whether estimated haemodynamics from history and physical examination reflect invasive measurements and predict outcomes in advanced heart failure.

History and physical examinations were performed for 388 patients enrolled in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial, and their findings were recorded on a standardised form.

About half of these patients also underwent an invasive right-heart catheterisation to measure how much fluid they had in their bodies.

Researchers found that the estimates of the amount of fluid from the history and physical exam compared favourably to the results of the invasive measurements.

Furthermore, patients who were estimated to have extra fluid through the collection of histories and physical exams were found to be at increased risk of being hospitalised or dying over the next 6 months.

"Our study touches upon an important clinical question: If physicians were more adept at performing histories and physicals, would they rely less on more costly diagnostic tests?" said Dr. Drazner.

"Hopefully, this study might shift the pendulum back just a bit towards using the history and physical examination in patient care. It might even get trainees more interested in learning about the history and physical examination so that this important art can be perpetuated in future generations of physicians."

SOURCE: Southwestern University Medical Center

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