New Diagnostic Integration Model of Cardiac Insufficiency in Primary Care - ICCAD 2017 - The 12th International Congress on Innovations in Coronary Artery Disease , 15-17 October, 2017 Venice, Italy

Ester Gavalda Espelta ¹ Alessandra Queiroga Gonçalves ² Maria Ferre Ferraté ¹ Aguilar Martin Carina ¹ Maria Teresa Irigoyen Garcia ¹ Montse Escriva Aguila ¹ Immaculada Izquierdo Zaragoza ¹ Dalmau Llorca Rosa ¹ Jordi Baucells Lluis ³ Jorgina Lucas Noll ¹ Boira Costa Miriam ¹

¹Direcció d'Atenció Primària, Gerència Territorial de l'Institut Català de la Salut. Terres de l'Ebre
²Idiap Jordi Gol, Unitat de Suport a la Recerca Terres de l’Ebre
³Departament Sistemes d'Informació i Comunicació, Gerència Territorial de l'Institut Català de la Salut. Terres de l'Ebre

Introduction: Cardiac Insufficiency(CI) is a clinical and care problem that has increased steadily in recent years.In patients with suspected diagnosis, Brain natriuretic peptides(BNP) plasma determination has been identified in different studies as an excellent method for the screening of left ventricular dysfunction. The importance of diagnosing CI as soon as possible, especially in the population with a greater risk of presenting it and poor accessibility from the Primary Care(PA) consultation to confirmatory diagnostic tests, such as echocardiography, impel us to search for new tools that facilitate the diagnostic confirmation of patients with suspected CI.
Objectives: Establish, through coordination between primary care and the referral hospital, an early diagnostic circuit for CI.
Material And Method: A computer application is created that allows a connection between primary and hospital care to establish the diagnosis of heart failure. Devices are distributed throughout the primary care centers to perform pro BNP measurements immediately to obtain a reference value through which a computer application allows the activation of the diagnostic route of heart failure.
When it is desired to request a BNP from a patient with suspected CI, the clinician accesses an application, fills the patient`s data (Framinghan criteria), draws blood to determine the BNP and records the result in the informatics application.If the result is positive the referral cardiologist receives a computer notice and he directly quotes the patient on a high resolution visit to perform the echocardiogram and the final diagnosis.
Results: During the years 2015-2016, 225 requests for ProBNP were made for the diagnosis of CI, (50 of them in our center). In our Basic Health Area, 31.4% of new CI diagnoses with echocardiography were performed in 2015 and 59.4% in 2016
Conclusions: The coordination between levels of care and the implementation of the care route in the diagnostic process of heart failure allows an early diagnosis of the problem with minimal repercussion for the patient