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Aims Identifying heart failure (HF) patients in general practice is challenging, and little is known about the current quality of care. We implemented an extended audit from the electronic health records (EHRs) of general practitioners (GPs) to identify HF patients and investigate patient characteristics and quality of care. Methods and resultsThis study describes the baseline results of the OSCAR-HF pilot study in eight general practices (51 GPs) in Flanders, Belgium. This prospective trial ran for 6 months. Interventions included an extended audit, an N-terminal pro-Btype natriuretic peptide point-of-care test, and assistance of a specialist HF nurse. The extended audit searched on risk factors for HF, HF symptoms, signs, and medication in the GPs' EHR to generate a list of possible HF patients. GPs determined which patients had HF. Those HF patients constituted the OSCAR-HF study population. Each patient file was manually revised to extract biomarker measurements, echocardiography data, and quality indicators. An independent panel of experts assessed the validity of GPs' HF diagnoses. Feedback about the validity of the HF diagnosis was given to the GP. Out of 18 011 patients ≥ 40 years, we identified 310 patients with a registered HF diagnosis before the study start (HF prevalence: 1.7%). The extended audit led to a 74% increase in identified HF patients (n ¼ 538, HF prevalence: 3.0%) with a mean age of 79 ± 11 years. The prevalence of HF with reduced ejection fraction (HFrEF) was 20% (n ¼ 110). A high proportion of patients underwent echocardiography in the past 5 years (86%, n ¼ 462). Natriuretic peptides were rarely available in patients' files (19%, n ¼ 100). Medical specialists should improve communication about the HF diagnosis because a specialist diagnosis was present in only 225 patients (42%) while 67% (n ¼ 359) of the HF diagnoses were judged objectified by a panel of experts. Assigning a diagnosis of HF was particularly difficult in HF patients with preserved EF (HFpEF). HFrEF treatment rates with renin-angiotensin-aldosterone system blockers (84%, n ¼ 92) and beta-blockers (86%, n ¼ 94) were very good; however, target doses were hardly reached (34% and 14%, respectively). Conclusions This study highlighted the need to improve case finding for HF in general practice and showed that an extended audit in the GPs' EHR was a successful strategy to do so. To improve the quality of HF care in general practice, specific strategies are needed to diagnose HFpEF and to reach target doses of disease-modifying drugs in HFrEF patients.

Background Patients with chronic heart failure (CHF) and patients with chronic obstructive pulmonary disease (COPD) are amenable to integrated palliative care (PC); however, despite the recommendation by various healthcare organizations, these patients have limited access to integrated PC services. In this study, we present the protocol of a feasibility prospective study that aims to explore if an “early integrated PC” intervention can be performed in an acute setting (cardiology and pulmonology wards) and whether it will have an effect on (i) the satisfaction of care and (ii) the quality of life and the level of symptom control of CHF/COPD patients and their informal caregivers. Methods A before-after intervention study with three phases, (i) baseline phase where the control group receives standard care, (ii) training phase where the personnel is trained on the application of the intervention, and (iii) intervention phase where the intervention is applied, will be carried out in cardiology and pulmonology wards in the University Hospital Leuven for patients with advanced CHF/COPD and their informal caregivers. Eligible patients (both control and intervention group) and their informal caregivers will be asked to complete the Palliative Outcome Scale, the CANHELP Lite, and the Advance Care Planning Questionnaire at the inclusion moment and 3 months after hospital discharge. Discussion The present study will assess the feasibility of carrying out PC-focused studies in acute wards for CHF/COPD patients and draw lessons for the further integration of PC alongside standard treatment. Further, it will measure the quality of life and quality of care of patients and thus shed light on the care needs of this population. Finally, it will evaluate the potential efficacy of the “early integrated palliative care” by comparing against existing practices. Trial registration Current Controlled Trials ISRCTN24796028 (date of registration August 30, 2018).

Piscivory is a common trophic niche among cichlids of the East African Great Lakes, including Lakes Edward and George. From these two lakes, we examined the taxonomic diversity of cichlid species with a piscivorous morphology. Prior to this study, two piscivorous species were formally described, Haplochromis squamipinnis and H. mentatus. We redescribe both species and describe an additional ten new species of Haplochromis with a piscivorous morphology: H. latifrons sp. nov., H. rex sp. nov., H. simba sp. nov., H. glaucus sp. nov., H. aquila sp. nov., H. kimondo sp. nov., H. falcatus sp. nov., H. curvidens sp. nov., H. pardus sp. nov., and H. quasimodo sp. nov. All twelve species differ in dominant male colour pattern (unknown for H. latifrons sp. nov. and H. curvidens sp. nov.) and morphological traits. The species can be divided into two morphological groups: the macrodontic piscivores and the microdontic piscivores. This division potentially reflects an ecological differentiation in habitat use, hunting technique, prey species, and prey size. We conclude that some 12–20% of the species from the cichlid assemblage of Lake Edward have a piscivorous morphology.